J Rheumatol. 2025 Nov 1:jrheum.2025-0475. doi: 10.3899/jrheum.2025-0475. Online ahead of print.
ABSTRACT
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 GEE analysis to assess associations with AAS.
RESULTS: Among 1,535 PsA patients, 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 (71.0%) and greater peripheral joint damage. Elevated ESR was observed in 86.7% of cases. Cox regression identified radiographic sacroiliitis (HR 6.61, 95% CI 1.64-26.67) as the strongest predictor of AAS, while male sex was associated with a lower hazard (HR 0.42, 95% CI 0.07-0.89). In GEE analysis, radiographic sacroiliitis (OR 3.64, 95% CI 1.6-8.24) and higher modified Steinbrocker scores were associated with AAS, whereas older age (OR 0.95, 95% CI 0.93-0.98) 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.
PMID:41176349 | DOI:10.3899/jrheum.2025-0475
