Degenerative and Inflammatory Osteoproliferations in Lumbar Radiographs in Psoriatic Arthritis Patients

The aim of this study was to determine the distribution different types of osteoproliferative lesions on the lumbar spine and their relations in patients with psoriatic arthritis (PsA) under biologic-disease-modifying anti-rheumatic drug therapy. T12-S1 corners were evaluated in 182/274 (66.4%) patients with lumbar radiographs. Lesions were determined as osteophyte (grade 0-3), erosion, sclerosis, squaring, corner syndesmophyte, and bridging syndesmophyte. Lesions with no clear distinction were defined as ambiguous. The mean (SD) age of 182 PsA (69.2% female) patients was 47.6 years (12.7), the mean age at diagnosis of PsA was 39.7 years (12.7). Of the patients, 112 (61.5%) met the criteria for mNY. Osteophytes were the most frequently detected lesions (42.3%), with 18.1% of patients having osteophyte grade 2 and above (mostly on L2-L4). Syndesmophytes were present in 24.2% of all patients (mostly on T12-L4), and ambiguous lesions were detected in 13 (4.7%) patients. Changes were observed in five ambiguous lesions in patients with follow-up lumbar radiography, four of them transformed into corner syndesmophytes at follow-up, and one was evaluated as osteophyte grade 2. Approximately one fifth of patients presented with significant degenerative new bone formation, and syndesmophytes were found in one fourth. In approximately 7% of all patients, lesions were ambiguous. The nature of these lesions needs to be evaluated in further imaging studies.