Evaluating Inflammatory Versus Mechanical Back Pain in Individuals with Psoriatic Arthritis: A Review of the Literature
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REVIEW
Evaluating Inflammatory Versus Mechanical Back Pain in Individuals with Psoriatic Arthritis: A Review of the Literature Linda L. Grinnell-Merrick . Eileen J. Lydon . Amanda M. Mixon . William Saalfeld
Received: June 23, 2020 / Accepted: September 3, 2020 The Author(s) 2020
ABSTRACT Psoriatic arthritis (PsA) is a chronic immune-mediated disease characterized by psoriatic skin and nail changes, peripheral joint inflammation, enthesitis, dactylitis, and/or axial involvement, either alone or in combination with each other. The presence of axial involvement has been shown to be a marker of PsA severity; however, there is no widely accepted definition of axial involvement in PsA (axPsA) or consensus on how or when to screen and treat patients with suspected axPsA. Chronic back pain is a prominent feature of axPsA and is thought to have a relevant role in early identification of disease. Chronic back pain can be caused by inflammatory back pain (IBP) or mechanical back pain (MBP). However, MBP can complicate recognition of IBP and Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12906404. L. L. Grinnell-Merrick (&) University of Rochester Medical Center, Rochester, NY, USA e-mail: [email protected] E. J. Lydon NYU Langone Medical Center, New York, NY, USA A. M. Mixon Arthritis and Rheumatology Clinic of Northern Colorado, Fort Collins, CO, USA W. Saalfeld Arthritis Center of Nebraska, Lincoln, NE, USA
delay diagnosis of axPsA. While MBP can also be associated with chronic back pain of C 3 months in duration that is typical of IBP, IBP is characterized by inflammation of the sacroiliac joint and lower spine that is differentiated from MBP by key characteristic features, including insidious onset at age \ 40 years, improvement with exercise but not with rest, and nighttime pain. This review discusses the differences in identification and management of IBP and MBP in patients with PsA with axPsA. The summary of available evidence highlights the importance of appropriate and timely screening, difficulties and limitations of differential diagnoses and treatment, and unmet needs in axPsA.
PLAIN LANGUAGE SUMMARY Psoriatic arthritis (PsA) is a long-term disease that may lead to psoriatic changes in skin and nails; inflammation of some joints, including finger and toe joints (dactylitis); inflammation of sites where tendons and ligaments connect to bone (enthesitis); and/or problems in the spine (axial involvement). Approximately 25–70% of patients with PsA have axial involvement (axPsA); this number varies because there is no widely accepted definition for axPsA. Chronic (long-lasting) back pain is a major feature of axSpA and can help doctors recognize axPsA early. Chronic back pain
Rheumatol Ther
can be caused by inflammatory back pain (IBP) or mechanical back pain (MBP). IBP is described by back pain lasting C 3 months, gradual onset at age \ 40 years, improvement with exercise, no improvement with rest, pain at night (with improvement
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