About one-third of the 7.5 million people in the United States living with psoriasis also have psoriatic arthritis (PsA). This chronic (ongoing) inflammatory condition causes pain and stiffness in joints, including the fingers, toes, and knees. However, about 25 percent to 75 percent of people with PsA experience this pain in their back and sacroiliac joints (at the pelvis and lower spine). This condition is a clinical form of PsA called axial psoriatic arthritis or psoriatic spondylitis.

Read on to learn more about PsA back pain, including what it feels and looks like compared to other conditions, how it’s diagnosed, and what treatment options are available.

Psoriatic Arthritis Back Pain

PsA back pain may occur at the start of disease progression or arise later. A main symptom of PsA of the spine is chronic inflammatory pain in the lower back, hips, and butt. PsA can cause inflammation in your sacroiliac joints, where the spine and pelvis meet near the hips and buttocks, which can cause pain.

It can be hard to identify PsA-related back pain and understand how it differs from back pain due to daily wear and tear, other conditions, or injuries. One MyPsoriasisTeam member said, “I am hurting today, especially in my back. I want to know how you can find out if the pain is osteoarthritis or psoriatic arthritis.”

PsA-related back pain has some key features. This type of pain can:

• Wake you up in the middle of the night
• Include back stiffness in the morning that lasts for 30 minutes or longer
• Improve after physical activity
• Get worse when you’re still for a long period

What Psoriatic Arthritis Back Pain Feels Like

MyPsoriasisTeam members, including those not yet diagnosed with PsA and those who’ve had multiple back surgeries, often discuss back pain.

One MyPsoriasisTeam member described feeling stiff: “When I bend down for a long time, I struggle to stand up properly. The same applies when I stand for too long. The area where the spine meets the pelvis and buttocks is so painful.”

Another member said, “My lower back feels as if I have a pinched nerve and is going down my right side.”

Members also discuss the frequency of back pain. One shared that their pain “disappears and then it reoccurs.”

It can help to know about others’ experiences, but PsA pain may feel different for every person. “I’ve learned that there is no one-size-fits-all for dealing with axial psoriatic arthritis,” noted one member.

When you discuss the pain with your doctor, try to describe your pain as specifically as possible, and let them know how often it occurs.

Other Symptoms of Psoriatic Arthritis

You may experience symptoms of PsA beyond back pain, such as joint pain in your hands and feet. Swelling and pain may affect your fingers and toes (dactylitis) or areas where tendons and ligaments connect to bone (enthesitis).

PsA may also cause symptoms unrelated to the joints, including:

• Scaly patches of skin, usually on the scalp, elbows, or knees
• Eye pain and redness, as well as blurry vision
• Nails with small dents or that separate from the nail bed
• Digestive symptoms related to inflammatory bowel disease

Reaching a Psoriatic Spondylitis Diagnosis

People with psoriasis may have undiagnosed or misdiagnosed PsA. Diagnosing PsA can be challenging, especially without skin symptoms. People who have both PsA and spondylitis may experience back symptoms for up to 10 years before receiving a diagnosis.

PsA symptoms are similar to rheumatoid arthritis, reactive arthritis, osteoarthritis, gout, and ankylosing spondylitis. This can make it hard to distinguish between the different conditions.

No single test can diagnose PsA, and there are no universally accepted criteria for its diagnosis. A dermatologist or rheumatologist can help determine if you have PsA and track its progression. Your doctor will likely review your medical history and order imaging tests and blood tests to confirm psoriatic spondylitis or rule out other conditions.

Medical History

Your doctor may diagnose PsA based on your symptoms and on your personal or family medical history. They’ll likely ask if you or a family member has had PsA or psoriasis, as 40 percent of people with these conditions have a family history of psoriatic disease.

Imaging

A healthcare provider can use imaging tests such as X-rays or ultrasound to check for damage or changes that may indicate PsA. An ultrasound can detect inflammation around your joints, and imaging tests can measure the progression of PsA over time.

Blood Tests

Your doctor may also ask for a blood sample. No specific markers in the blood indicate PsA, but certain proteins can point to inflammation and help your doctor make an appropriate diagnosis. In particular, your doctor may look for the presence of HLA-B27, a gene that’s linked with a higher risk of spinal involvement.

Treating Psoriatic Arthritis Back Pain

Early diagnosis is key to starting treatment promptly and preventing irreversible joint damage. PsA treatment focuses on managing pain and inflammation while slowing disease progression, which can help ease back pain.

For back pain, nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, are usually the first treatment option and can be an effective over-the-counter choice. If pain and inflammation persist despite NSAIDs, your doctor may suggest biologic therapy such as tumor necrosis factor (TNF) inhibitors, interleukin-17 inhibitors, or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) like Janus kinase (JAK) inhibitors.

Although synthetic DMARDs are effective for PsA, they don’t work on spine involvement. However, your doctor may recommend these drugs to help with symptoms in other areas, such as skin, eyes, or joints affected by enthesitis or dactylitis.

If you experience persistent back pain, talk to a doctor or rheumatologist to help identify the cause. If PsA is contributing to your pain, a combination of lifestyle changes and treatments may provide relief.

Talk With Others Who Understand

On MyPsoriasisTeam, the social network for people with psoriatic disease and their loved ones, members come together to ask questions, give advice, and share their experiences with others who understand life with psoriasis and psoriatic arthritis.

What does your psoriatic arthritis back pain feel like? What has helped manage your pain? Share your experience in the comments below, or post a question on your Activities page.