Anterior chest wall in spondyloarthritis: a common denominator or just a coincidence?

This editorial refers to ‘Sternoclavicular joint involvement in psoriatic arthritis: a hidden indicator of disease severity’ by Pankti Mehta et al. 2025; https://doi.org/10.1093/rheumatology/keaf583. PsA is a complex and heterogeneous inflammatory rheumatic disease, associated with comorbidities of the cardiometabolic spectrum. Up to ∼30% of patients with psoriasis develop the disease, with both sexes equally affected [1]. The clinical phenotype is characterized by peripheral arthritis, which varies between oligoarticular and polyarticular forms, with distal interphalangeal joints also affected; other musculoskeletal manifestations include enthesitis, dactylitis and axial involvement [1]. Recently in Rheumatology, Mehta et al. examined the prevalence and the clinical associations of sternoclavicular joint (SCJ) involvement in PsA. In this large retrospective observational cohort study, researchers observed that SCJ involvement was present in 10.5% of patients, with approximately one-third affected at baseline, indicating that it may represent an early manifestation of PsA. Furthermore, SCJ involvement was significantly associated with higher swollen joint counts and the presence of enthesitis, but not with the presence of HLA-B27. Treatment with biologic or targeted synthetic DMARDs was associated with less frequent SCJ involvement. Nevertheless, the absence of imaging data for all patients in this study may have led to under detection of subclinical SCJ. Notably, this analysis did not assess other anterior chest wall (ACW) joints, such as the acromioclavicular and manubriosternal joints [2].