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Rheumatology (Oxford). 2019 Oct 8. pii: kez457. doi: 10.1093/rheumatology/kez457. [Epub ahead of print]

Is axial psoriatic arthritis distinct from ankylosing spondylitis with and without concomitant psoriasis?

Feld J1,2, Ye JY1, Chandran V1,2,3,4, Inman RD1,2,5, Haroon N1,2,4, Cook R6, Gladman DD1,2,3.

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Krembil Research Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto.
Institute of Medical Science, University of Toronto, Toronto.
Division of Rheumatology, Department of Medicine, University of Toronto, Toronto.
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto.
Department of Immunology, Medical Sciences Building, University of Toronto, Toronto.
Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada.



The aim of this study was to compare patients with ankylosing spondylitis with psoriasis (ASP) and without psoriasis (AS), to axial PsA (axPsA) patients.


Two adult cohorts were recruited from the AS clinic: ASP and AS. These two cohorts were compared with two adult cohorts recruited from the PsA clinic: axPsA (radiographic sacroiliitis: ⩾bilateral grade 2 or unilateral grade 3 or 4); and Peripheral PsA. All patients were followed prospectively according to the same protocol. The demographic, clinical and radiographic variables were compared. Adjusted means were used to account for varying intervals between visits. A logistic regression was performed and adjusted for follow-up duration.


There were 477 axPsA patients, 826 peripheral PsA, 675 AS and 91 ASP patients included. AS patients were younger (P < 0.001), more male and HLA-B*27 positive (76%, 72% vs 64%, P ⩽ 0.001, 82%, 75%, vs 19%, P = 0.001). They had more back pain at presentation (90%, 92% vs 19%, P = 0.001), worse axial disease activity scores (bath ankylosing spondylitis disease activity index: 4.1, 3.9 vs 3.5 P = 0.017), worse back metrology (bath ankylosing spondylitis metrology index: 2.9, 2.2 vs 1.8, P < 0.001), worse physician global assessments (2.4, 2.2 vs 2.1, P < 0.001), were treated more with biologics (29%, 21% vs 7%, P = 0.001) and had a higher grade of sacroiliitis (90%, 84% vs 51%, P < 0.001). Similar differences were detected in the comparison of ASP to axPsA and in a regression model.


AS patients, with or without psoriasis, seem to be different demographically, genetically, clinically and radiographically from axPsA patients. axPsA seems to be a distinct entity.


ankylosing; arthritis; axial; psoriatic; spondylitis

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