- Psoriatic arthritis is a condition not only affecting the large joints in the body but the spine as well.
- Some people with this condition develop spondylitis, or inflammation between the spine and pelvis.
- Other contributors to back pain in people with psoriatic arthritis also include obesity and sedentary lifestyles.
Psoriatic arthritis is a form of inflammatory arthritis that causes joint pain, swelling and stiffness. It typically affects the large joints especially those of the lower extremities and distal joints of the fingers and toes.
However, it can also affect the spine, causing pain in the back and pelvis area, which commonly occurs in people with psoriatic arthritis, according to Dr. John Davis III, psoriatic arthritis and axial spondyloarthritis specialist at Mayo Clinic in Rochester, Minnesota.
How Does Psoriatic Arthritis Affect the Spine?
Some people develop a condition called spondylitis or axial arthritis as a result of psoriatic arthritis. Spondylitis causes inflammation of the joints between the vertebrae of the spine and in the joints between your spine and pelvis, also called your sacroiliac joints.
“Spondylitis leads to inflammation around the ligaments that hold the spine together,” causing back pain as well as reduced range of motion, says Dr. Rajat Bhatt, a rheumatologist at Memorial Hermann Health System in Texas.
Obesity and a sedentary lifestyle in people with psoriatic arthritis also contribute to mechanical back pain, adds Dr. Bhatt.
How Prevalent is Spondylitis in People With Psoriatic Arthritis?
Around 7 to 32 percent of people with psoriatic arthritis suffer from spondylitis, according to estimates from the National Psoriasis Foundation.
Although spondylitis can occur later in life, the Arthritis Foundation states that in most cases, people are diagnosed with the condition before they reach their 40s. Back pain from the condition also tends to affect men more than women.
Additionally, people with axial arthritis experience nail changes and more joint damage. About 12.5 percent of people with psoriatic arthritis who had spondylitis were found in an October 2018 study in the Journal of Rheumatology to have higher risks for moderate to severe psoriasis.
Signs that Psoriatic Arthritis is affecting the Spine
According to Davis, you may experience:
- Back pain that worsens with rest and gets better when you’re moving
- Back stiffness in the morning lasting at least 30 minutes
- Inflammatory pain around your hips and butt
- Lesser range of motion
To diagnose spondylitis, your doctor may recommend an MRI scan to see changes in the bones and soft tissues of the spine and pelvis.
How to know if your Back Pain is Tied To Psoriatic Arthritis or Something Else
If your back is causing you discomfort, see your doctor to know the root cause, which include:
Another form of inflammatory arthritis, ankylosing spondylitis is often confused with psoriatic arthritis wherein the vertebrae in the spine fuses, leading to back pain as well as more chances of losing spinal mobility. An MRI of the back will help determine if you have axial-psoriatic arthritis or ankylosing spondylitis, says Davis.
Mechanical back pain
This often results from injury or being obese or overweight. According to Bhatt and Davis, this type of pain is worse when moving than resting, unlike spondylitis. Mechanical back pain also causes momentary back stiffness in the morning compared to lingering morning stiffness often experienced in spondylitis.
Davis adds that individuals with psoriatic arthritis may also have back pain associated with other causes,such as:
- osteoarthritis of the spine, or the degenerative joint disease of the spine
- spinal stenosis, where the narrowing spine spaces trigger nerve pain
- fibromyalgia, or widespread musculoskeletal pain
- central sensitization, where the central nervous system ramps up pain sensations
Treatments for Psoriatic Arthritis in the Spine
Early detection and treatment can lower the risk off progressive loss of spinal mobility and function. Below are recommended treatments that can help ease the pain and other symptoms related with spondylitis in people with psoriatic arthritis.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin
- Disease-modifying antirheumatic drugs (DMARDs), including methotrexate, leflunomide, sulfasalazine
- Corticosteroid injections
- Tumor necrosis factor (TNF) inhibitors (e.g. adalimumab, etanercept, certolizumab, infliximab, golimumab)
- Biologic drugs, including interleukin (IL)-12, IL-17, or IL-23 inhibitors (e.g. guselkumab, ixekizumab, secukinumab, ustekinumab)
- Physical therapy
Source: Everyday Health