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Interspinous ligamentitis in patients with psoriatic arthritis
Jack Arnold1,2,3, Muthusamy Chandramohan2, Philip S Helliwell1,2,3
1Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Posterior soft-tissue inflammation, specifically interspinous ligamentitis, is a key cause of inflammatory back pain in psoriatic arthritis (PsA). This finding may be missed in MRI reports focusing on sacroiliac joints and vertebral bodies.
Area of Science:
- Rheumatology
- Immunology
- Radiology
Background:
- Axial involvement in psoriatic arthritis (axPsA) presents heterogeneously compared to axial spondyloarthritis (axSpA).
- Posterior soft-tissue inflammation is an underrecognized cause of back pain in axPsA.
Purpose of the Study:
- To illustrate the presentation of posterior soft-tissue inflammation as a cause of inflammatory back pain in axPsA.
- To highlight interspinous ligamentitis as a potential finding in axPsA.
Main Methods:
- Case series of five patients with psoriatic arthritis and inflammatory back pain.
- Clinical and demographic data extraction from medical records.
- Spine and sacroiliac joint imaging performed per local protocols.
Main Results:
- All patients had peripheral symptoms and inflammatory back pain.
- All five patients exhibited posterior spinal soft-tissue inflammation, predominantly interspinous ligamentitis.
- Three patients showed sacroiliitis, and two had vertebral enthesitis on imaging.
Conclusions:
- Interspinous ligamentitis is a significant cause of inflammatory back pain in axPsA.
- This finding may be overlooked in MRI reports prioritizing sacroiliac joints and vertebral bodies.
- Identifying interspinous ligamentitis could impact treatment strategies for axPsA.
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