Cervical spine involvement in psoriatic arthritis.
The clinical and radiographic manifestations of cervical spine involvement in psoriatic arthritis remain incompletely described. Only one case-control study has been reported.


OBJECTIVE
To conduct a case-control study of the clinical and radiographic manifestations of cervical spine involvement in psoriatic arthritis.


METHODS
30 psoriatic arthritis patients (mean age, 53.3 years (21-78); sex ratio, 1; mean disease duration, 80.4 months (12-204); and mean Ritchie's index, 9.3 (2-30)) were compared with 30 controls with common low back pain (mean age, 53.8 years (21-78)). Each patient underwent a physical examination, completed a questionnaire on function, underwent cervical spine radiography (anteroposterior and lateral views and views in flexion and extension). All radiographs were evaluated by an independent observer.


RESULTS
Patients were more likely than controls to have neck pain (22/30 (73%) vs 8/30 (26%) P < 0.001). Among subjects with neck pain, the time pattern was more likely to be inflammatory in the patients than in the controls (14/22 vs 1/8, P < 0.001). Functional impairment and pain severity were significantly greater in the patients. On radiographs, facet joint abnormalities (osteophytes, joint space loss, sclerosis) were significantly more common (P < 0.01) in the patients, particularly at C3-C4 and C4-C5. Also more common in the patients were signs of spondylitis (7 vs 0) and of facet joint arthritis (7 vs 2). No subjects had syndesmophytes. Three (10%) patients had anterior C1-C2 subluxation with an atlas-dens interval greater than 4 mm. Within the patient group, no correlations were found between clinical patterns and radiographic findings.


CONCLUSIONS
Our data confirm that psoriatic arthritis frequently involves the cervical spine, with the facet joints being a preferred target, and can cause anterior C1-C2 subluxation.
Jeannou
J
J
Rheumatology Department, Trousseau Teaching Hospital, Tours, France.
Goupille
P
P
Avimadje
M A
MA
Zerkak
D
D
Valat
J P
JP
Fouquet
B
B
D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000150:complications*; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged