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About one-third of the 7.5 million people in America living with psoriasis also have psoriatic arthritis, or PsA. This chronic (ongoing) inflammatory condition causes pain and stiffness in the joints, typically in the legs, fingers, and toes. However, about 20 percent of people with PsA will feel it in the spine, which may also be called psoriatic spondylitis or axial psoriatic arthritis.
PsA back pain may occur late in the disease’s progression. The primary symptom of PsA of the spine is chronic pain in the lower back and the sacroiliac joints (where the spine and pelvis meet near the hips and buttocks).
Inflammatory back pain from PsA is different from back pain caused by daily wear and tear. PsA-related back pain usually:
Besides back pain, you may also have other symptoms of PsA, including joint pain in your hands and feet. You may notice dactylitis (inflammation in fingers and toes) and enthesitis (inflammation where tendons and ligaments connect to bone).
PsA may also cause symptoms unrelated to the joints, including:
Back pain is frequently discussed by MyPsoriasisTeam members, from those who have not yet been diagnosed with PsA to those who have had multiple back surgeries.
One member questioned the cause of the back pain: “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. I do know I have osteoarthritis — but the pain is worse now.” Another said, “Having severe pain in my back and hips today because of this cold weather.”
One member shared the experience of living with psoriatic arthritis: “I’ve had spine issues for more than 30 years and have had three spine surgeries. I’ve learned that there is no one-size-fits-all for dealing with axial psoriatic arthritis.”
To take care of the back, this member said, “I walk every other day for up to 40 minutes — except in the winter, when I have to be more flexible with my walking routine due to the cold. I need the rest days in between so that I can recover. Resting is just as important, but too much rest will cause more pain and stiffness.”
Approximately 15 percent of people with psoriasis may have PsA that’s unrecognized or undiagnosed. Diagnosing PsA, especially in the absence of skin symptoms of psoriasis, can be challenging. PsA symptoms are similar to rheumatoid arthritis, osteoarthritis, gout, and ankylosing spondylitis. People who have both PsA and spondylitis may experience back-related symptoms for as many as 10 years before being diagnosed.
There’s no single test to diagnose PsA. There are also no universally accepted diagnostic criteria for PsA. A dermatologist or rheumatologist can help determine whether you have PsA and track how far your condition has progressed. Your doctor will likely take a medical history, imaging tests, and blood tests to confirm psoriatic spondylitis or rule out other conditions.
Doctors can sometimes make a PsA diagnosis based on your symptoms and by obtaining a family history or personal history. Your doctor will likely ask if you or a family member previously had PsA or psoriasis. Having a family member who has or has had psoriatic disease is one of the main risk factors for developing PsA. Forty percent of people with PsA have a family history of psoriatic disease. The Spondylitis Association of America reports that if an identical twin has PsA, there’s a 75 percent chance that the other twin will have it as well.
A health care provider can use imaging tests such as CT scans, MRI scans, ultrasound, and X-rays to detect PsA and any damage to the soft tissues. Imaging tests can also be used to measure the progression of PsA over time.
Your doctor may also ask for a blood sample. No specific markers in the blood indicate PsA, but certain proteins in the blood 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 is associated with a higher risk of spinal involvement.
Early diagnosis is important for beginning treatment promptly and preventing long-term, irreversible joint damage. PsA treatment aims to manage pain and inflammation and to slow or halt disease progression.
Many medications, including corticosteroid injections and NSAIDs, can be used to manage the inflammatory pain of PsA.
Disease-modifying antirheumatic drugs (DMARDs) may sometimes be used to help slow disease progression and prevent lasting joint and tissue damage.
Examples of conventional DMARDs include:
Newer DMARDs, including tofacitinib (Xeljanz) and apremilast (Otezla), target specific parts of the immune system that contribute to the body’s inflammation.
Biologics, such as tumor necrosis factor (TNF) inhibitors, also target specific proteins that cause inflammation. TNF inhibitors can slow or stop PsA progression for some people. TNF inhibitors include:
Biologic DMARDs to treat PsA back pain also include secukinumab (Cosentyx), ustekinumab (Stelara), and ixekizumab (Taltz).
If you have lasting back pain, talk to a doctor or rheumatologist to help you discover the cause. If PsA is causing you pain, certain lifestyle changes and treatments can help.
MyPsoriasisTeam is the social network for people with psoriatic disease and their loved ones. More than 116,000 members come together to ask questions, give advice, and share their experiences with others who understand life with psoriasis and psoriatic arthritis.
Do you have psoriatic arthritis back pain? Has anything worked to help manage it? Share your experience in the comments below or join the conversation on MyPsoriasisTeam.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Nyaka Mwanza has worked with large global health nonprofits focused on improving health outcomes for women and children. Learn more about her here.
Scarlett Bergam, M.P.H. is a medical student at George Washington University and a former Fulbright research scholar in Durban, South Africa. Learn more about her here.
