Psoriatic arthritis is a chronic inflammatory disease that affects the joints and areas where ligaments and tendons connect to bones. Spondylitis psoriatic arthritis, also known as psoriatic spondylitis, is a type of psoriatic arthritis affecting the spine and pelvic joints.
The National Psoriasis Foundation states that more than 8 million people in the United States have psoriasis. Among people with psoriasis, about 30% may develop psoriatic arthritis (PsA). In turn, 20% of people with PsA may develop spondylitis PsA.
In this article, we examine spondylitis psoriatic arthritis and its causes. We also look at the possible symptoms of the condition and its treatment options.
People with psoriasis often have inflamed and discolored, scaly patches of skin in the affected areas of the body.
About 10 years after developing psoriasis, people may start experiencing joint inflammation, which can affect any joint. Spondylitis PsA occurs when this inflammation develops in the back, hips, and neck.
Spondylitis PsA progresses differently in each individual. In some cases, a person may develop arthritis symptoms before they notice any symptoms of psoriasis.
Both psoriasis and PsA are autoimmune conditions in which the body’s defense systems against disease mistakenly attack healthy cells.
Autoimmune conditions can cause symptoms to fluctuate. As a result, people with spondylitis PsA sometimes feel fine but have swollen joints at other times. They may also experience fatigue, a heavy tiredness.
Doctors consider ankylosing spondylitis (AS) and spondylitis PsA as part of the spondyloarthritis (SpA) spectrum. SpA is the umbrella term for inflammatory conditions that affect the spinal area, including:
- the back
- the neck
- the pelvis
- larger joints
- some internal organs
The following table compares the two:
|Back pain||always affects the spine||likely to affect peripheral joints as well as the back|
|Joint pain||affects large joints, such as the shoulders, hips, and knees||usually affects smaller joints too, such as fingers and toes|
|Skin and nail issues||rare for AS to affect the skin and nails||skin and nail issues are common|
Spondylitis PsA symptoms may include:
- lower back and hip pain, although the symptoms may affect other joints
- a reduced range of motion in the joints
- stiffness in the morning that wears off after 30 minutes or more
- fatigue that does not improve after rest
- changes to the nails on the fingers or toes
- swelling of a single finger or toe
- enthesitis, which is the inflammation of areas where tendons and ligaments attach to bones
- uveitis, which is eye inflammation
- inflammatory bowel disease
Researchers need to conduct more research on the causes of spondylitis PsA. However, some factors that may play a role in the condition include:
- having psoriasis or arthritis
- having a close relative with psoriasis or arthritis
- infections, including strep throat
- being aged 30–50 years
Spondylitis PsA is not infectious and cannot pass from person to person.
A doctor will diagnose spondylitis PsA by asking about the symptoms, including swollen, painful joints, arthritis patterns, and skin and nail differences that link to psoriasis. They will also take a medical history and carry out a physical examination, including joint range-of-motion assessments.
In some cases, the doctor may request blood tests for rheumatoid factor and an anti-CCP antibody to exclude rheumatoid arthritis (RA). These blood tests are ordinarily negative for people with spondylitis PsA but produce positive results in people with RA.
The doctor may also request X-rays, ultrasound scans, and MRI scans to check the joints in more detail.
The aim of treatment is to reduce symptoms and minimize damage to the joints. Different treatments are available, depending on the type and severity of the symptoms. Doctors may recommend the following treatment options:
Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically the first form of treatment that doctors provide for reducing pain and inflammation. NSAIDs include ibuprofen, naproxen, indomethacin, and meloxicam.
Also known as disease-modifying antirheumatic drugs, these medications help relieve symptoms and may prevent joint damage. If one DMARD does not work, doctors may recommend another. DMARDs are
DMARDs include drugs such as methotrexate, leflunomide, and sulfasalazine. They may take several weeks to be effective, but they are suitable for long-term use.
Biologics are a more recent form of treatment that doctors often use when standard treatments are unsuccessful. They are the preferred treatment for spondylitis, as they target specific parts of the immune system rather than the entire system. Doctors give them by injection or intravenous infusion.
One type, known as tumor necrosis factor (TNF) inhibitors, works by limiting a protein called TNF, which causes inflammation. TNF-inhibitors include infliximab, etanercept, and adalimumab.
Interleukin inhibitors, which target interleukin proteins, are another form of biological therapy. The options include ustekinumab and secukinumab.
Biologics often take up to 3 months to provide their maximum benefit, but they can start working very quickly.
Exercise is an important therapy in the treatment of traditional arthritis. Exercising affected joints could promote the maintenance of good mobility and help reduce pain and stiffness. Exercises can help improve posture, which may reduce the symptoms of spondylitis PsA.
People with conditions affecting the joints should speak with a healthcare professional before starting a new exercise regimen.
Diet and nutrition
Paying attention to the food they eat may help a person with spondylitis PsA maintain a moderate weight. Reducing alcohol intake and following a diet with adequate calcium and vitamin D can help strengthen the bones. Eating various nutritious foods, including vegetables and fruit, and reducing salt and sugar intake can help maintain good health and reduce overall inflammation.
If a medication affects how a body processes some vitamins or minerals, a vitamin supplement may be helpful. For example, methotrexate
A person should always consult a medical professional before changing their diet to help spondylitis PsA.
Complementary remedies may help relieve pain from spondylitis PsA if a person uses them alongside traditional medication. Complementary remedies include acupuncture to help ease pain, yoga to relieve stress and maintain mobility, and therapeutic massage.
A person should ask for medical advice before visiting a chiropractor because spinal manipulation may not be suitable for treating some conditions. Some people with spondylitis PsA may also find that massage does not provide pain relief.
A TENS unit that stimulates the skin by applying electrical current may help alleviate pain in some people, as may applying cold and warm compresses.
Spondylitis PsA has links with several other conditions, including:
- type 2 diabetes
- high blood pressure
- high cholesterol
- heart disease
- permanent damage to the joints, including fusion of the spine
Receiving treatment for spondylitis PsA at an early stage may minimize the likelihood of these other conditions.
Spondylitis PsA is PsA that affects the spine, neck, pelvis, and hips. It differs from AS in the areas of the body that it typically affects.
Early diagnosis is important to reduce the damage to joints.
Treatment options include medication, exercise, and treatment for joint pain. Treatment is essential to avoid other conditions that can happen due to inflammation in the body.
A person should consult a healthcare professional if they have any symptoms of spondylitis PsA.