What to know about psoriatic spondylitis
People with psoriatic spondylitis may experience pain, inflammation, and stiffness in their neck and lower back. It can also affect the sacroiliac joints in the pelvis. Over time, the condition may make it more difficult for a person to move their spine.
In this article, we take a closer look at psoriatic spondylitis, including its causes, symptoms, and treatments.
What is psoriatic spondylitis?
Psoriatic spondylitis can cause pain, inflammation, and stiffness in the neck and lower back.
Psoriatic spondylitis is a form of psoriatic arthritis.
Psoriatic arthritis refers to a group of inflammatory joint problems related to psoriasis. However, not everyone who has psoriatic arthritis has psoriasis.
Psoriatic spondylitis occurs when the body’s immune system attacks its own tissue, which leads to inflammation and often painful symptoms.
How common is it?
Psoriasis is one of the most common autoimmune diseases in the United States, affecting more than 8 million people in America, according to the National Psoriasis Foundation (NPF).
The NPF also estimate that 10–30 percent of people with psoriasis will develop psoriatic arthritis, though different sources give different estimates.
About 20 percent of people with psoriatic arthritis develop psoriatic spondylitis, according to the Spondylitis Association of America.
Psoriatic spondylitis causes symptoms that are similar to other forms of arthritis that affect the spine and the sacroiliac joints in the pelvis, such as ankylosing spondylitis and reactive arthritis.
Symptoms of psoriatic spondylitis include:
- back pain
- stiffness in the back or neck that improves when moving around
- stiffness made worse by periods of staying still, such as sleep
- trouble bending or moving the back
These symptoms can cause extreme pain and some people experience difficulty in their daily lives. Left untreated, the inflammation can cause long-term damage to the spine and joints.
Medical treatments aim to keep inflammation under control and prevent long-term joint problems and damage. Medication can also reduce a person’s risk of heart disease that can occur due to inflammation.
The symptoms of psoriatic spondylitis may seem to come and go. When symptoms get worse, this is known as a flare. The location of pain and swelling may also change over time.
Doctors are still unsure why some people develop psoriatic disease, but others do not.
Certain infections, such as strep throat, may trigger the overactive immune response that causes psoriatic spondylitis. However, psoriatic spondylitis is not contagious.
The condition tends to run in families.
One of the most significant risk factors for psoriatic spondylitis is the HLA-B27 gene. This gene also has links to several different autoimmune diseases.
Blood tests can detect whether a person carries the HLA-B27 gene. However, testing positive for the HLA-B27 gene does not mean a person will get psoriatic spondylitis. Other genes may cause psoriatic spondylitis.
Psoriatic spondylitis usually develops in people who already have psoriasis, but this is not always the case.
Age is also a risk factor. Psoriatic arthritis typically occurs in people between 30 and 50 years old.
A person with psoriatic spondylitis may experience hearing loss.
Psoriatic spondylitis can cause long-term damage to the bones and joints in the spine, neck, and pelvis. It may also cause complications such as:
Not every person who has psoriatic spondylitis will experience these complications. The best way to prevent complications occurring is to receive prompt treatment and follow a doctor’s recommendations.
The NPF website has an online quiz that people can do to help them work out whether they may have psoriatic arthritis. Anyone who thinks they may have the condition can visit their doctor to find out more.
Initially, a doctor may ask the person to fill out a screening tool for psoriatic arthritis.
They may also use a variety of other tests to determine whether a person has psoriatic spondylitis. Firstly, they rule out other types of arthritis and other causes of back pain. This is important because treatment for psoriatic spondylitis and other types of arthritis are different.
Along with joint-related symptoms, a doctor may also look for signs of psoriasis, such as silvery scales on the skin and pitted or crumbling nails.
Doctors may also use imaging tests, such as X-rays, MRI scans, ultrasounds, and CT scans to look at the bones and joints in the spine.
Doctors also do blood tests to help diagnose psoriatic spondylitis because people with this condition can have high levels of inflammation in the blood. People who have psoriatic spondylitis also may have lower red blood cell counts.
Doctors can use blood tests to rule out other forms of arthritis.
Psoriatic spondylitis symptoms can be difficult and painful, but doctors can treat the condition.
The aim of treatment for psoriatic spondylitis treatment is to prevent damage to the bones and joints, help a person manage symptoms, and achieve remission. Remission means a person has no symptoms and the disease is not getting worse.
However, people will need to use medications long-term to stay symptom-free.
A variety of medications are available to treat psoriatic spondylitis, including:
Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve mild psoriatic spondylitis pain, reduce inflammation, and relieve stiffness. However, NSAIDs can have side effects, such as stomach bleeding and kidney impairment, especially when a person takes them for long periods. Talk to a doctor about how to use NSAIDs safely.
NSAIDs include ibuprofen, naproxen, and aspirin, as well as prescription options.
Disease-modifying antirheumatic drugs
Disease-modifying antirheumatic drugs (DMARDs) control inflammation or the body’s overactive immune response. They can help relieve symptoms of psoriatic spondylitis and prevent damage to joints. A person may take them as a pill or get an injection.
DMARDs include the following classes of drugs:
- drugs that suppress the immune system response, such as methotrexate, azathioprine, leflunomide, and cyclosporine
- drugs that control inflammation in the body, including sulfasalazine and acthar therapy
- biologics, which target specific immune cells to reduce inflammation
Biologics are a newer, more targeted therapy than DMARDs. Doctors administer this medicine through injections. Biologics work by interfering with natural immune pathways, mimicking the natural molecules, and reducing inflammation.
- tumor necrosis factor-alpha (TNF) inhibitors, including etanercept, adalimumab, and infliximab
- T-cell inhibitors, such as abatacept
- other inhibitors target specific inflammatory proteins, such as ustekinumab, secukinumab, and ixekizumab
Not everyone will need biologics as a primary treatment. Biologics may increase a person’s risk of infection or cause specific side effects, such as flu-like symptoms or airway infections. Rarely, they can cause blood disorders, cancer, and other autoimmune symptoms. Talk to a doctor about the benefits, risks, and costs of biologics.
Corticosteroids are powerful anti-inflammatory drugs. A person may take a corticosteroid pill such as prednisone, or a doctor may inject the medicine directly into the affected joint. These can provide short-term relief.
Doctors usually prescribe corticosteroids to treat severe severe flares until other medication, such as biologics or DMARDs, start to work.
Corticosteroid medication can have side effects that include weight gain, osteoporosis, and high blood pressure. Psoriasis may flare up when a person stops using steroids.
Small molecule medications
Small molecule medications stop certain immune molecules from attacking the joints and skin. They include:
Exercise helps lessen the inflammation around the joints and helps to relieve pain. Stronger muscles also help support the joints, putting less stress on them.
A physical therapist can recommend specific stretches and exercises to help a person who has psoriatic spondylitis. An occupational therapist can recommend ways that a person can prevent joint stress and suggest how they can adapt their work environment to reduce pain and injury.
Some home remedies may also be useful for milder cases.
Partaking in low-impact exercise, such as biking, can help keep joints flexible.
Using home remedies for psoriatic spondylitis can help ease symptoms. These remedies work alongside a doctor’s treatment plan. Follow a doctor’s advice on medications or other treatments to avoid future bone and joint damage.
The following natural and home remedies may help a person manage their psoriatic spondylitis:
- Exercise. Being active can help keep joints flexible. It can also help people maintain a healthful weight, which can take pressure off painful joints. Exercise boosts endorphins, which may help improve a person’s emotional well-being. Walking, biking, yoga, and Tai Chi are good low-impact choices. Some people find swimming to be easier on painful joints.
- Follow a regular sleep schedule. Fatigue can make psoriatic spondylitis symptoms feel worse. It can also trigger more inflammation in the body. Focus on getting enough sleep and maintaining a regular bedtime.
- Know the triggers. Keep a journal with foods, activities, and life events and write down when the psoriatic spondylitis gets worse. This can help identify the causes of flares so that people can avoid them in the future.
- Try acupuncture. A recent meta-analysis found that acupuncture was an effective option for reducing chronic musculoskeletal pain.
- Get a massage. A licensed massage therapist may use a variety of techniques to relieve tension and loosen stiff joints. Make sure the massage therapist has experience in treating people with psoriatic spondylitis or arthritis.
- Eat an anti-inflammatory diet. Nutritious whole foods can help fight fatigue. A Mediterranean Diet can help fight inflammation. Learn more about anti-inflammatory foods here.
- Limit or avoid alcohol. Drinking alcohol may interfere with medications a person takes for psoriatic spondylitis and may cause unwanted side effects.
- Quit smoking. Smoking makes the symptoms of psoriatic arthritis worse. Quitting smoking can have a wide range of health benefits alongside relieving joint pain.
- Try hot or cold therapy. Some people find relief from the pain by using heating pads or cold packs on sore areas. Take periodic breaks to avoid burning the skin or getting frostbite.
- Manage stress. High stress levels can make psoriatic spondylitis symptoms worse.
Many people find the symptoms of psoriatic spondylitis challenging, but with the variety of treatments available today, many people can manage their symptoms, prevent further joint damage, and carry out normal activities.
While there is no cure for psoriatic spondylitis, a person can keep symptoms under control with the help and guidance of their healthcare team. Following an effective treatment plan can help people with psoriatic spondylitis lead healthy and active lives.