Frequency and characteristics of axial involvement in psoriatic arthritis: results from the International Multicentre AXIS Study

Torgutalp M, Almodovar R, Azevedo VF, Baraliakos X, Bosch FVd, Braun J, Chandran V, Coates LC, Deodhar A, Diekhoff T, Fagni F, Floris A, Gaalen FA, Garcia-Salinas R, Gensler LS, Goel N, Gottlieb AB, Heijde Dvd, Helliwell PS, Hermann KGA, Kalyoncu U, Kiltz U, Kynaston-Pearson F, Lambert RG, Laxminarayan R, Leung YY, Llop M, López-Medina C, López-Rodríguez A, Gentiloni MM, Lunteren Mv, Magrey M, Maharaj AB, Maldonado-Ficco H, Maksymowych WP, Marzo-Ortega H, Massarotti M, Mathew AJ, Mease P, Nash P, Navarro-Compán V, Østergaard M, Proft F, Protopopov M, Ranza R, Rohekar S, Salvarani C, Schiotis RE, Shenker N, Sieper J, Solmaz D, Soriano ER, Shan Tam L, Toledo RAd, Wei JC, Ziade N, Gladman DD, Poddubnyy D (2026)

Publication Type: Journal article

Publication year: 2026

Journal

DOI: 10.1016/j.ard.2026.02.025

Abstract

ObjectivesThe Axial Involvement in Psoriatic Arthritis (AXIS) cohort aimed at evaluating the frequency of and clinical and imaging features of axial involvement in psoriatic arthritis (PsA).MethodsAXIS (NCT04434885) is a prospective, multicentre, cross-sectional study conducted in 19 countries, by the Assessment of SpondyloArthritis International Society and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis. Participants with a diagnosis of PsA meeting ClASsification criteria for Psoriatic ARthritis with musculoskeletal symptom duration ≤10 years and no prior exposure to biological or targeted synthetic disease-modifying antirheumatic drugs were consecutively included. Standardised clinical, laboratory, and imaging assessments (radiography and magnetic resonance imaging of the axial skeleton, including sacroiliac joints [SIJs] and spine), were performed. Imaging was reviewed locally and centrally to detect axial involvement. The presence of axial involvement was determined by local investigator judgement before and after central-imaging review.ResultsAmong 409 participants, axial involvement was identified in 153 (37.4%) based on the investigator’s initial assessment and was decreased to 112 (27.4%) in the final evaluation after incorporating central-imaging review. Participants with axial involvement were younger (45.2 ± 13.8 vs 47.6 ± 12.6 years), more often male (56.3% vs 51.5%), and had a higher frequency of human leukocyte antigen (HLA)-B*27 positivity (22.4% vs 10.8%), inflammatory back pain (IBP) (74.7% vs 43.4%), and elevated C-reactive protein (CRP) (52.7% vs 37.4%). Active inflammatory and structural imaging changes were highly discriminative between participants with and without axial involvement. The central review identified imaging signs of axial involvement (active inflammation or structural lesions) in 95 participants (23.2%).ConclusionsAxial involvement was identified in 27.4% of participants with PsA after final diagnostic assessment, with associated features including HLA-B*27 positivity, IBP, elevated CRP, and imaging changes in SIJ or spine.

Authors with CRIS profile

Involved external institutions

Charité - Universitätsmedizin Berlin Germany (DE) Hospital Universitario Fundación Alcorcón (HUFA) Spain (ES) Universidade Federal do Paraná (UFPR) Brazil (BR) Rheumazentrum Ruhrgebiet Germany (DE) Universiteit Gent (UGent) / Ghent University Belgium (BE) University Health Network (UHN) Canada (CA) University of Oxford United Kingdom (GB) Oregon Health and Science University (OSHU) United States (USA) (US) Università degli Studi di Cagliari Italy (IT) Leiden University Medical Center Netherlands (NL) Hospital Italiano La Plata Argentina (AR) University of California San Francisco (UCSF) United States (USA) (US) Duke University United States (USA) (US) Icahn School of Medicine at Mount Sinai United States (USA) (US) Western University Canada (CA) Università degli Studi di Modena e Reggio Emilia (UNIMORE) Italy (IT) University of Leeds United Kingdom (GB) Hacettepe University Turkey (TR) University Hospitals of Derby and Burton NHS Foundation Trust United Kingdom (GB) University of Alberta Canada (CA) Queen's Hospital United Kingdom (GB) Singapore General Hospital Singapore (SG) Institute of Research and Innovation Parc Tauli (IRIPT) / Institut d'Investigació i Innovació Parc Taulí (I3PT) Spain (ES) Hospital Universitario Reina Sofía de Córdoba Edificio IMIBIC Spain (ES) San Javier Guadalajara Hospital Mexico (MX) Università Politecnica delle Marche (UNIVPM) / Marche Polytechnic University Italy (IT) Case Western Reserve University United States (USA) (US) Walter Sisulu University South Africa (ZA) Christchurch Hospital United Kingdom (GB) Christian Medical College & Hospital India (IN) Swedish Medical Center United States (USA) (US) Griffith University Australia (AU) Hospital Universitario La Paz Spain (ES) Rigshospitalet Denmark (DK) Universidade Federal Uberlândia Brazil (BR) Cambridge University Hospitals United Kingdom (GB) İzmir Kâtip Çelebi Üniversitesi Turkey (TR) Hospital Italiano de Buenos Aires Argentina (AR) The Chinese University of Hong Kong (CUHK) China (CN) Faculdade de Medicina de São José do Rio Preto (FAMERP) Brazil (BR) Chung Shan Medical University / 中山醫學大學 Taiwan (TW) Hôtel-Dieu de France Lebanon (LB)

How to cite

APA:

Torgutalp, M., Almodovar, R., Azevedo, V.F., Baraliakos, X., Bosch, F.V.d., Braun, J.,... Poddubnyy, D. (2026). Frequency and characteristics of axial involvement in psoriatic arthritis: results from the International Multicentre AXIS Study. Annals of the Rheumatic Diseases. https://doi.org/10.1016/j.ard.2026.02.025

MLA:

Torgutalp, Murat, et al. "Frequency and characteristics of axial involvement in psoriatic arthritis: results from the International Multicentre AXIS Study." Annals of the Rheumatic Diseases (2026).

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