Prevalence and predictors of cervical involvement in psoriatic spondyloarthropathy

Cervical spondylitis has been reported in 35%-75% of patients with psoriatic arthritis (PsA), and this likely represents the highest frequency of cervical involvement among the spondyloarthropathies. Although 2 patterns of cervical spondylitis have been recognized in PsA, this may reflect a lack of a satisfactory definition of cervical spondylitis in PsA. In a retrospective cross-sectional study, we analyzed the clinical records of 100 consecutive patients recruited at a single university hospital who were diagnosed as having psoriatic spondyloarthropathy on the basis of radiographic sacroiliitis. All patients were involved in a clinicoradiologic study of the cervical column to evaluate the frequency and the predictors of this involvement. Forty-one patients showed radiographic signs of cervical involvement and 24 of them (58.5%) complained of cervical pain and stiffness, whereas 17 (41.5%) had radiologic disease with no symptoms. Arthritis duration (odds ratio, 1.08; 95% confidence interval, 0.99-1.19; p < 0.05) and peripheral erosive disease (odds ratio, 2.5; 95% confidence interval, 1.91-6.92; p < 0.05) were found to be associated with cervical spondylitis development. This study showed a high frequency of cervical spondylitis among patients with psoriatic spondyloarthropathy, confirming previous reports. Although none of our patients developed neurologic sequelae, this report also showed that clinical symptoms of cervical pain and stiffness are not a universal predictor of involvement of the cervical spine, and therefore, patients with PsA with longer disease duration and erosive disease should be screened radiologically to detect those cervical lesions (i.e., atlantoaxial subluxation) with potential catastrophic complications.