The Journal of rheumatology · 2026
Atlantoaxial Subluxation in Patients With Psoriatic Arthritis.
СтатьяНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Carrizo-Abarza Virginia, Kharouf Fadi, Mehta Pankti, Gao Shangyi, Pereira Daniel, Cook Richard J, Poddubnyy Denis, Gladman Dafna D, Chandran Vinod
Аннотация
OBJECTIVE: We aimed to investigate the prevalence and incidence of atlantoaxial subluxation (AAS) in psoriatic arthritis (PsA), identify associated risk factors, and describe the clinical and radiographic characteristics of affected patients.
METHODS: We included individuals from our observational cohort of PsA, excluding those with a history of trauma or cervical spine surgery. We calculated prevalence and incidence of AAS, and we used descriptive statistics to summarize and compare baseline demographic and disease-related characteristics between patients with and without AAS. Additionally, we used Cox regression with time-varying covariates to identify factors linked to AAS development and performed multivariable generalized estimating equations (GEE) analysis to assess associations with AAS.
RESULTS: Among 1535 patients with PsA, 34 (2.21%) were identified with AAS, including 20 at baseline and 14 during follow-up, with an incidence of 1.16 per 1000 person-years. Patients with AAS had higher rates of radiographic sacroiliitis (64.71%) and greater peripheral joint damage. Elevated erythrocyte sedimentation rate (ESR) was observed in 84.85% of cases. Cox regression identified radiographic sacroiliitis (hazard ratio [HR] 6.61, 95% CI 1.64-26.67) as the strongest predictor of AAS, whereas male sex was associated with a lower hazard (HR 0.25, 95% CI 0.07-0.89). In GEE analysis, radiographic sacroiliitis (odds ratio [OR] 3.64, 95% CI 1.61-8.24) and higher modified Steinbrocker scores (OR 1.01, 95% CI 1.00-1.02) were associated with AAS, whereas older age (OR 0.95, 95% CI 0.92-0.98) and male sex (OR 0.40, 95% CI 0.17-0.92) were associated with lower ORs.
CONCLUSION: AAS is an uncommon complication in PsA strongly associated with radiographic sacroiliitis and radiographic damage in peripheral joints.
METHODS: We included individuals from our observational cohort of PsA, excluding those with a history of trauma or cervical spine surgery. We calculated prevalence and incidence of AAS, and we used descriptive statistics to summarize and compare baseline demographic and disease-related characteristics between patients with and without AAS. Additionally, we used Cox regression with time-varying covariates to identify factors linked to AAS development and performed multivariable generalized estimating equations (GEE) analysis to assess associations with AAS.
RESULTS: Among 1535 patients with PsA, 34 (2.21%) were identified with AAS, including 20 at baseline and 14 during follow-up, with an incidence of 1.16 per 1000 person-years. Patients with AAS had higher rates of radiographic sacroiliitis (64.71%) and greater peripheral joint damage. Elevated erythrocyte sedimentation rate (ESR) was observed in 84.85% of cases. Cox regression identified radiographic sacroiliitis (hazard ratio [HR] 6.61, 95% CI 1.64-26.67) as the strongest predictor of AAS, whereas male sex was associated with a lower hazard (HR 0.25, 95% CI 0.07-0.89). In GEE analysis, radiographic sacroiliitis (odds ratio [OR] 3.64, 95% CI 1.61-8.24) and higher modified Steinbrocker scores (OR 1.01, 95% CI 1.00-1.02) were associated with AAS, whereas older age (OR 0.95, 95% CI 0.92-0.98) and male sex (OR 0.40, 95% CI 0.17-0.92) were associated with lower ORs.
CONCLUSION: AAS is an uncommon complication in PsA strongly associated with radiographic sacroiliitis and radiographic damage in peripheral joints.