Occurrence of cervical spine arthritis with prominent bone edema highly responsive to adalimumab in a patient with psoriatic peripheral arthritis and long-standing remission

Abstract

Cervical spine involvement frequently occurs in patients with psoriatic arthritis (PsA) even in absence of sacroiliitis. Long disease duration, high disease activity in the first five years and presence of peripheral involvement are all predictors of this peculiar articular involvement. We describe the case of a PsA patient, with an initial oligoarthritis pattern of disease highly responsive to etanercept monotherapy and long-standing clinical remission, who developed cervical spine involvement with bone marrow edema of odontoid process and early atlo-axial instability. Notably, he did not exhibit any other clinical symptom or sign of disease activity and was highly responsive to switching to a second anti-TNF drug (adalimumab). The case stresses the importance of strict monitoring PsA patients and considering the possible changing pattern of disease. Early identification of cervical spine involvement requires proper use and interpretation of imaging techniques. Interestingly different articular manifestations of PsA may show different response to therapy even in the same patient.