Clinical and morphological features and possibilities of trapanbiopsy in the diagnosis of psoriatic spondyloarthritis: a series of clinical observations and a review of the literature

Psoriatic spondyloarthritis is a rare and poorly studied group of non-infectious autoimmune inflammatory lesions of the spine, belonging to the group of axial spondyloarthritis. There are no systematic data on the diagnosis and course of spondylitis in patients with psoriasis in the literature. The aim of the study is to present the results of the clinical course and features of the diagnosis of chronic spondylitis in patients with psoriasis and to systematize the literature data on the issue under consideration. The clinical part of the study included six patients successively operated on in the period from 2018 to 2021. The diagnosis of gouty spondylitis and aseptic chronic spondylitis was suspected according to the CASPAR questionnaire (Classification Criteria for Psoriatic ARthritis, 2006) and established on the basis of the ASDAS (Ankylosing Spondylitis Disease Activity Score) and BASDAI (Bath Ankylosing Spondylitis Activity Index). The features of clinical, laboratory, radiation and histological manifestations of the disease were studied. All patients underwent vertebral trephine biopsy with hemotoxylin-eosin staining and Romanovsky – Giemsa examination. The literature was systematized using the medical literature databases PubMed, Google Scholar, eLIBRARY. The search depth was from 2013 to 2023. The average age of patients was 37.8±5.2 years with a psoriasis duration of 14.3±75 years. The average value for five signs of the CASPAR questionnaire was 3.5±0.4. According to the ASDAS-CRP and BASDAI indices, moderate disease activity was noted – 2.6±0.3 (Mmin – 1.8, Mmax – 3.1) and 2.5±0.4 (Mmin – 1.6, Mmax – 2.8), respectively, which was confirmed by a moderate increase in CRP – 8.2±2.4 mg/l (Mmin – 5.7, Mmax – 14.2). When analyzing the quality of life and functioning of the spine, patients complained of significant pain (VAS 5–6 points) and difficulty sitting, lifting objects and standing), which corresponded to moderate disorders according to the ODI and SF 36 questionnaires. In three (50 %) of six patients, radiographic signs of damage to the sacroiliac joints were detected. Traditional histological examination of biopsy material revealed dystrophic changes in bone tissue with a nonspecific leukocyte reaction. A more indepth histological examination and staining of the preparation according to Romanovsky – Giemsa revealed clusters of mast cells characteristic of psoriasis. The presence of psoriasis, vertebrogenic pain syndrome, exceeding 3.5 points according to the CASPAR criteria and detection of signs of spondylitis, aseptic spondylitis and/or sacroiliitis in MRI allow us to suspect psoriatic spondyloarthritis. In this group of patients, according to the BASDAI and ASDAS indices, markers of the systemic inflammatory response, there was moderate activity. Staining biopsy material according to Romanovsky – Giemsa in destructive processes in the spine allows not only to exclude granulomatous, oncological and pyogenic etiology of the disease, but also to suspect psoriatic spondyloarthritis and select individual treatment for the disease.

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