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:
- hearing loss
- some types of cancer, including lymphoma and nonmelanoma skin cancer
- heart disease
- metabolic syndrome
- Crohn's disease
- liver disease
- inflammation of the eyes, known as uveitis
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 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.
Treatment aims to prevent damage to the bones and joints, manage symptoms, and achieve remission. Remission means a person has no symptoms, and the disease is not getting worse.
Biologics can reduce the severity of symptoms and the number of flares and slow the progress of PsA by targeting specific parts of the immune system.
Guidelines published in 2018 recommend biologic therapy for most people who have a new diagnosis of PsA, either as an injection or an infusion.
However, biologics will not suit everyone, as they can cause side effects and increase the risk of infections and other health issues.
A doctor will discuss the benefits, risks, and costs of biologics and alternative treatments with the individual.
Small molecule medications
People who cannot use biologic therapy may use an alternative treatment known as oral small molecule medications. These stop immune molecules from attacking the joints and skin.
- apremilast (Otezla)
- tofacitinib (Xeljanz)
Disease-modifying antirheumatic drugs
Disease-modifying antirheumatic drugs (DMARDs) may either help reduce inflammation or suppress the body's immune response.
Examples of DMARDs include:
- 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
DMARDs can help relieve symptoms and prevent long-term joint damage. Depending on the type, a person may take them as a pill or as an injection.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve mild psoriatic spondylitis pain, reduce inflammation, and relieve stiffness. They include ibuprofen, naproxen, and aspirin, as well as prescription options.
However, long-term NSAID use can have side effects, such as stomach bleeding and kidney impairment. Talk to a doctor about how to use NSAIDs safely.
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.
Corticosteroids can provide short-term relief when symptoms are severe.
Frequent or long-term use can lead to side effects, including weight gain, osteoporosis, and high blood pressure.
Psoriasis may flare up when a person stops using steroids.
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 a person keep their joints flexible and maintain a healthy weight, which can take pressure off painful joints. Exercise boosts endorphins, which may help improve a person's emotional well-being. Current guidelines recommend low-impact activities, such as tai chi, yoga, and swimming, for people with PsA.
- 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 may worsen the symptoms of psoriatic arthritis, including joint pain. Guidelines encourage doctors to recommend a smoking cessation program to any individual with psoriasis who needs help with quitting.
- 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.