Torgutalp Murat, Käding Henriette, Proft Fabian
Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Ther Adv Musculoskelet Dis. 2025 Jul 27;17:1759720X251357532. doi: 10.1177/1759720X251357532. eCollection 2025.
Spondyloarthritis is a group of chronic inflammatory diseases that includes axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). AxSpA primarily affects the axial skeleton, manifesting with hallmark features such as inflammatory back pain and a strong association with human leukocyte antigen-B27. On the other hand, axial involvement in PsA (axial PsA) poses unique challenges in the diagnosis, classification, and management. These challenges stem from a limited understanding of this condition and an absence of a specific definition for its diagnosis. Although shared genetic and environmental contributors are observed, the presence of differences suggests the possibility that axial PsA may, in fact, represent a distinct clinical entity rather than axSpA. The prevailing classification criteria, such as ClASsification criteria for Psoriatic ARthritis for PsA and the Assessment of SpondyloArthritis International Society criteria for axSpA, are insufficient in capturing the full scope of axial PsA. Moreover, treatment paradigms for axial PsA are primarily extrapolated from axSpA due to the lack of targeted trials in this specific population. Biologic disease-modifying anti-rheumatic drugs, encompassing tumor necrosis factor inhibitors, interleukin (IL)-17 inhibitors, and Janus kinase inhibitors, have demonstrated efficacy in axSpA and PsA. However, IL-23 inhibitors have not shown efficacy in axSpA, and currently, no results from randomized controlled trials in axial PsA are available. While axial PsA exhibits features that overlap with axSpA, emerging evidence underscores its distinct pathophysiology and clinical characteristics, highlighting the need for standardized definitions and tailored therapeutic approaches to optimize outcomes. Ongoing studies evaluating therapeutic efficacy and molecular characterization hold promises to enhance understanding and management of axial PsA, thus paving the way for personalized treatment strategies. This review aims to provide an overview of the similarities and differences between axial PsA and axSpA and seeks to disentangle the intersections between these two diseases.
脊柱关节炎是一组慢性炎症性疾病，包括轴性脊柱关节炎（axSpA）和银屑病关节炎（PsA）。AxSpA主要影响中轴骨骼，表现出如炎性背痛等标志性特征，且与人类白细胞抗原-B27密切相关。另一方面，PsA的中轴受累（轴性PsA）在诊断、分类和管理方面带来了独特的挑战。这些挑战源于对这种情况的了解有限以及缺乏针对其诊断的具体定义。尽管观察到有共同的遗传和环境因素，但差异的存在表明轴性PsA实际上可能代表一种独特的临床实体，而非axSpA。现行的分类标准，如PsA的银屑病关节炎分类标准和axSpA的国际脊柱关节炎评估协会标准，不足以涵盖轴性PsA的全部范围。此外，由于缺乏针对这一特定人群的靶向试验，轴性PsA的治疗模式主要是从axSpA推断而来。生物改善病情抗风湿药物，包括肿瘤坏死因子抑制剂、白细胞介素（IL）-17抑制剂和Janus激酶抑制剂，已在axSpA和PsA中显示出疗效。然而，IL-23抑制剂在axSpA中未显示出疗效，目前也没有轴性PsA的随机对照试验结果。虽然轴性PsA表现出与axSpA重叠的特征，但新出现的证据强调了其独特的病理生理学和临床特征，突出了需要标准化定义和量身定制的治疗方法以优化治疗结果。正在进行的评估治疗效果和分子特征的研究有望增进对轴性PsA的理解和管理，从而为个性化治疗策略铺平道路。本综述旨在概述轴性PsA和axSpA之间的异同，并试图厘清这两种疾病之间的交叉点。
