title: The Definition and Measurement of Axial Psoriatic Arthritis.
abstract: This review seeks to update the state of the art of axial psoriatic arthritis (axPsA). The definition and assessment of axPsA can be problematic because no agreement and no definitive data on this topic have been published, resulting in uncertainty as to the best approach to deal with these patients. A few recent scientific reports show new data on the possible coincidence of diffuse idiopathic skeletal hyperostosis and axPsA, as well as on the radiological assessment as measured with the validated instruments for axPsA. Moreover, the role of magnetic resonance imaging has also been evaluated for this intriguing subset. All data confirmed that radiological assessment is a useful tool to detect typical findings of axPsA, while other imaging techniques remain to be validated. Finally, there is no evidence to support treatment of axPsA with traditional disease-modifying antirheumatic drugs, while a "leap" to biologic agents is the only treatment after failure with nonsteroidal antiinflammatory drugs.
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Rheumatology Department, Istituto Ortopedico G. Pini, Milan; Rheumatology Department of Lucania, "S. Carlo Hospital," Potenza and Madonna Delle Grazie Matera, Potenza and Matera; Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua; and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; W.J. Parsons, BSc, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Department, Istituto Ortopedico G. Pini; I. Olivieri, MD, Consultant Rheumatologist and Head of Rheumatology Department, Rheumatology Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; S. D'Angelo, MD, Consultant Rheumatologist, Rheumatology, Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; A. Cauli, MD, PhD, Aggregate Professor of Rheumatology, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; F. Caso, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Costa, MD, Assistant Professor of Rheumatology, Rheumatology Unit, Department of Medicine DIMED, University of Padua; Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, Associate Professor of Rheumatology and Head of Rheumatology Department, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; L. Brunese, MD, Chair and Professor of Radiology, Department of Medicine and Health Sciences, University of Molise. enniolubrano@hotmail.
authors.forename: Ennio
authors.initials: E
authors.lastname: Lubrano
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Rheumatology Department, Istituto Ortopedico G. Pini, Milan; Rheumatology Department of Lucania, "S. Carlo Hospital," Potenza and Madonna Delle Grazie Matera, Potenza and Matera; Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua; and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; W.J. Parsons, BSc, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Department, Istituto Ortopedico G. Pini; I. Olivieri, MD, Consultant Rheumatologist and Head of Rheumatology Department, Rheumatology Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; S. D'Angelo, MD, Consultant Rheumatologist, Rheumatology, Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; A. Cauli, MD, PhD, Aggregate Professor of Rheumatology, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; F. Caso, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Costa, MD, Assistant Professor of Rheumatology, Rheumatology Unit, Department of Medicine DIMED, University of Padua; Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, Associate Professor of Rheumatology and Head of Rheumatology Department, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; L. Brunese, MD, Chair and Professor of Radiology, Department of Medicine and Health Sciences, University of Molise.
authors.forename: Wendy Joanne
authors.initials: WJ
authors.lastname: Parsons
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Rheumatology Department, Istituto Ortopedico G. Pini, Milan; Rheumatology Department of Lucania, "S. Carlo Hospital," Potenza and Madonna Delle Grazie Matera, Potenza and Matera; Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua; and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; W.J. Parsons, BSc, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Department, Istituto Ortopedico G. Pini; I. Olivieri, MD, Consultant Rheumatologist and Head of Rheumatology Department, Rheumatology Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; S. D'Angelo, MD, Consultant Rheumatologist, Rheumatology, Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; A. Cauli, MD, PhD, Aggregate Professor of Rheumatology, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; F. Caso, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Costa, MD, Assistant Professor of Rheumatology, Rheumatology Unit, Department of Medicine DIMED, University of Padua; Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, Associate Professor of Rheumatology and Head of Rheumatology Department, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; L. Brunese, MD, Chair and Professor of Radiology, Department of Medicine and Health Sciences, University of Molise.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marchesoni
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Rheumatology Department, Istituto Ortopedico G. Pini, Milan; Rheumatology Department of Lucania, "S. Carlo Hospital," Potenza and Madonna Delle Grazie Matera, Potenza and Matera; Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua; and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; W.J. Parsons, BSc, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Department, Istituto Ortopedico G. Pini; I. Olivieri, MD, Consultant Rheumatologist and Head of Rheumatology Department, Rheumatology Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; S. D'Angelo, MD, Consultant Rheumatologist, Rheumatology, Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; A. Cauli, MD, PhD, Aggregate Professor of Rheumatology, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; F. Caso, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Costa, MD, Assistant Professor of Rheumatology, Rheumatology Unit, Department of Medicine DIMED, University of Padua; Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, Associate Professor of Rheumatology and Head of Rheumatology Department, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; L. Brunese, MD, Chair and Professor of Radiology, Department of Medicine and Health Sciences, University of Molise.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Olivieri
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Rheumatology Department, Istituto Ortopedico G. Pini, Milan; Rheumatology Department of Lucania, "S. Carlo Hospital," Potenza and Madonna Delle Grazie Matera, Potenza and Matera; Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua; and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; W.J. Parsons, BSc, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Department, Istituto Ortopedico G. Pini; I. Olivieri, MD, Consultant Rheumatologist and Head of Rheumatology Department, Rheumatology Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; S. D'Angelo, MD, Consultant Rheumatologist, Rheumatology, Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; A. Cauli, MD, PhD, Aggregate Professor of Rheumatology, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; F. Caso, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Costa, MD, Assistant Professor of Rheumatology, Rheumatology Unit, Department of Medicine DIMED, University of Padua; Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, Associate Professor of Rheumatology and Head of Rheumatology Department, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; L. Brunese, MD, Chair and Professor of Radiology, Department of Medicine and Health Sciences, University of Molise.
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Angelo
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Rheumatology Department, Istituto Ortopedico G. Pini, Milan; Rheumatology Department of Lucania, "S. Carlo Hospital," Potenza and Madonna Delle Grazie Matera, Potenza and Matera; Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua; and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; W.J. Parsons, BSc, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Department, Istituto Ortopedico G. Pini; I. Olivieri, MD, Consultant Rheumatologist and Head of Rheumatology Department, Rheumatology Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; S. D'Angelo, MD, Consultant Rheumatologist, Rheumatology, Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; A. Cauli, MD, PhD, Aggregate Professor of Rheumatology, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; F. Caso, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Costa, MD, Assistant Professor of Rheumatology, Rheumatology Unit, Department of Medicine DIMED, University of Padua; Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, Associate Professor of Rheumatology and Head of Rheumatology Department, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; L. Brunese, MD, Chair and Professor of Radiology, Department of Medicine and Health Sciences, University of Molise.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cauli
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Rheumatology Department, Istituto Ortopedico G. Pini, Milan; Rheumatology Department of Lucania, "S. Carlo Hospital," Potenza and Madonna Delle Grazie Matera, Potenza and Matera; Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua; and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; W.J. Parsons, BSc, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Department, Istituto Ortopedico G. Pini; I. Olivieri, MD, Consultant Rheumatologist and Head of Rheumatology Department, Rheumatology Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; S. D'Angelo, MD, Consultant Rheumatologist, Rheumatology, Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; A. Cauli, MD, PhD, Aggregate Professor of Rheumatology, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; F. Caso, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Costa, MD, Assistant Professor of Rheumatology, Rheumatology Unit, Department of Medicine DIMED, University of Padua; Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, Associate Professor of Rheumatology and Head of Rheumatology Department, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; L. Brunese, MD, Chair and Professor of Radiology, Department of Medicine and Health Sciences, University of Molise.
authors.forename: Francesco
authors.initials: F
authors.lastname: Caso
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Rheumatology Department, Istituto Ortopedico G. Pini, Milan; Rheumatology Department of Lucania, "S. Carlo Hospital," Potenza and Madonna Delle Grazie Matera, Potenza and Matera; Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua; and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; W.J. Parsons, BSc, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Department, Istituto Ortopedico G. Pini; I. Olivieri, MD, Consultant Rheumatologist and Head of Rheumatology Department, Rheumatology Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; S. D'Angelo, MD, Consultant Rheumatologist, Rheumatology, Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; A. Cauli, MD, PhD, Aggregate Professor of Rheumatology, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; F. Caso, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Costa, MD, Assistant Professor of Rheumatology, Rheumatology Unit, Department of Medicine DIMED, University of Padua; Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, Associate Professor of Rheumatology and Head of Rheumatology Department, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; L. Brunese, MD, Chair and Professor of Radiology, Department of Medicine and Health Sciences, University of Molise.
authors.forename: Luisa
authors.initials: L
authors.lastname: Costa
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Rheumatology Department, Istituto Ortopedico G. Pini, Milan; Rheumatology Department of Lucania, "S. Carlo Hospital," Potenza and Madonna Delle Grazie Matera, Potenza and Matera; Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua; and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; W.J. Parsons, BSc, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Department, Istituto Ortopedico G. Pini; I. Olivieri, MD, Consultant Rheumatologist and Head of Rheumatology Department, Rheumatology Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; S. D'Angelo, MD, Consultant Rheumatologist, Rheumatology, Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; A. Cauli, MD, PhD, Aggregate Professor of Rheumatology, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; F. Caso, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Costa, MD, Assistant Professor of Rheumatology, Rheumatology Unit, Department of Medicine DIMED, University of Padua; Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, Associate Professor of Rheumatology and Head of Rheumatology Department, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; L. Brunese, MD, Chair and Professor of Radiology, Department of Medicine and Health Sciences, University of Molise.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scarpa
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Rheumatology Department, Istituto Ortopedico G. Pini, Milan; Rheumatology Department of Lucania, "S. Carlo Hospital," Potenza and Madonna Delle Grazie Matera, Potenza and Matera; Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua; and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; W.J. Parsons, BSc, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Department, Istituto Ortopedico G. Pini; I. Olivieri, MD, Consultant Rheumatologist and Head of Rheumatology Department, Rheumatology Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; S. D'Angelo, MD, Consultant Rheumatologist, Rheumatology, Department of Lucania, "S. Carlo Hospital," and Madonna Delle Grazie Matera; A. Cauli, MD, PhD, Aggregate Professor of Rheumatology, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; F. Caso, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Costa, MD, Assistant Professor of Rheumatology, Rheumatology Unit, Department of Medicine DIMED, University of Padua; Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, Associate Professor of Rheumatology and Head of Rheumatology Department, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; L. Brunese, MD, Chair and Professor of Radiology, Department of Medicine and Health Sciences, University of Molise.
authors.forename: Luca
authors.initials: L
authors.lastname: Brunese
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D001175:Arthrography; D001688:Biological Products / Q000627:therapeutic use; D003661:Decision Support Techniques; D003952:Diagnostic Imaging / Q000379:methods; D004185:Disability Evaluation; D006801:Humans; D007596:Joints / Q000187:drug effects / Q000473:pathology; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001688:Biological Products
keywords: AXIAL INVOLVEMENT; BATH ANKYLOSING SPONDYLITIS RADIOLOGY INDEX; MODIFIED STOKE ANKYLOSING SPONDYLITIS SPINE SCORE; PSORIATIC ARTHRITIS; PSORIATIC ARTHRITIS SPONDYLITIS RADIOLOGY INDEX; RADIOGRAPHIC SCORING METHODS