Psoriatic arthritis tends to develop in the large joints, particularly in the hands and feet. However, it can also affect the spine, causing pain in the back and pelvic area. Psoriatic arthritis is most common in people with psoriasis or individuals with a family history of the disease. Around 30 percent of people with psoriasis develop this type of arthritis.
When psoriatic arthritis affects the spine, doctors refer to it as axial arthritis, meaning that it affects the spine, shoulders, or hips. Axial arthritis occurs in up to 50 percent of people with psoriatic arthritis. If this type of arthritis affects the spine, it often affects the extremities as well.
How does psoriatic arthritis affect the spine?
Psoriatic arthritis can cause pain and inflammation in any part of the spine. A person may develop the following complications over time:
- Psoriatic spondylitis: This involves inflammation in the joints between the vertebrae, which are the small bones that form the spine.
- Sacroiliitis: This involves inflammation of the joints between the spine and the pelvis.
The joints between the vertebrae in the spinal column enhance mobility and movement. Psoriatic arthritis can cause inflammation in any or all of these joints, and a person will feel pain and stiffness where the inflammation occurs. In a person with psoriatic arthritis, lower back pain can indicate swelling in the joints between the vertebrae.
Psoriatic arthritis vs. ankylosing spondylitis
It may be difficult for a doctor to determine whether a person has psoriatic arthritis in the spine or ankylosing spondylitis. Both conditions cause pain and stiffness in the spinal joints. Ankylosing spondylitis is a form of arthritis that mainly affects the spine, but it can develop in other joints. It causes inflammation and severe discomfort. In serious cases, new bone matter forms, fusing the bones in the spine and significantly limiting mobility.
To ensure correct diagnosis of psoriatic arthritis or ankylosing spondylitis, a person should see a rheumatologist. They will assess the person’s symptoms and take into account the family history and the results of imaging and blood tests when making a diagnosis.
Symptoms of psoriatic arthritis in the spine
Psoriatic arthritis in the spine can also develop in other areas, such as the hands and feet. Symptoms can range from mild to severe. A person with this type of arthritis in the spine may experience any combination of the following symptoms:
- back pain that disrupts sleep
- pain that gets better with exercise and worse with rest
- pain with no known cause
- pain in the hips or buttocks
- skin issues, including scaly plaques that may be itchy
- reduced range of motion in the affected joints
- general fatigue
- joint stiffness, which may last for more than 30 minutes, after rest or in the morning
Symptoms of psoriatic arthritis can grow worse, then lessen or disappear for a time. Many people refer to a period of worsened symptoms as a flare.
A treatment plan for psoriatic arthritis in the spine may include a combination of the following:
- biologic drugs, which can help control inflammation and prevent the condition from progressing
- nonsteroidal anti-inflammatory drugs, or NSAIDs
- pain relief medications
- corticosteroid injections, which can reduce inflammation and swelling
- physical therapy to retain flexibility in the spine
Doctors use a combination of disease-modifying antirheumatic drugs and interleukin 6 inhibitors to treat psoriatic arthritis in the limbs, hands, and feet. A person may know the drugs better as DMARDs and IL-6 inhibitors. However, these medications do not effectively treat psoriatic arthritis in the spine.
Exercises and stretches for the spine
Physical therapy and exercise can help a person with psoriatic arthritis maintain or regain mobility and flexibility. A physical therapist can advise people on the best exercises. Some people benefit from doing seated spinal twists several times a day to help with mobility. To do this stretch:
- sit in a chair with your back straight and your feet on the floor
- twist your torso slowly to one side and hold it for a beat
- repeat this, twisting to the other side
People with psoriatic arthritis should also get regular exercise.
Cardiovascular exercise, in particular, can help with reaching or maintaining a healthy weight, which will reduce the arthritic symptoms. Some good options for a person with psoriatic arthritis include:
A person can do any sport or exercise that they are comfortable with, but consult a doctor before taking part in contact sports or heavy exercise.
Complications and side effects
If a person does not receive the correct treatment, psoriatic arthritis can cause permanent joint damage, which may lead to changes in the shapes of the joints. Treatment can prevent or slow down the progression of the condition.
Psoriatic arthritis also increases the risk of developing other conditions, including:
There is no cure for psoriatic arthritis. However, effective treatment can prevent or slow down the progression of the condition. Treatments for psoriatic arthritis can vary, depending on the affected part of the body.
Consult a physical therapist about exercises that can maintain and improve flexibility in the spine.
Receiving a diagnosis and treatment early can prevent joint damage in the spine and other parts of the body