Psoriatic Arthritis and Back Pain: What You Need to Know

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Psoriatic arthritis is a inflammatory type of arthritis that develops in some people with psoriasis, an autoimmune disease that causes skin cells to build up and form scaly plaques. Psoriasis affects 74 million adults in the United States, and about 30% of patients diagnosed with psoriasis develop psoriatic arthritis.

Psoriatic arthritis causes inflammation in many joints of the body because the immune system is attacking its own joints. It commonly affects the lumbar spine, or low back.

woman suffering from low back pain

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Symptoms

Psoriatic arthritis is characterized by joint pain, inflammation, and stiffness that develops in addition to skin symptoms. Some people with this condition may not have symptoms on their skin at all.

The widespread inflammation that affects the skin and joints in psoriatic arthritis can also extend to other areas of the body, causing nail changes, swollen fingers or toes with a sausage-like appearance called dactylitis, inflammation of the eyes called uveitis, and inflammation of the sites where tendons and ligaments attach to the bone called enthesitis.

Other systemic symptoms of psoriatic arthritis can include chronic fatigue, digestive symptoms—such as abdominal pain, bloating, constipation, and diarrhea—and organ damage from inflammation of the heart, lungs, or kidneys.

Back Pain

While psoriatic arthritis can affect any joint, axial involvement that causes pain and inflammation of the spine usually occurs more often with more severe cases of psoriatic arthritis. Involvement of the spine affects approximately 25% to 75% of patients with psoriasis.

It is typically associated with a greater extent of psoriasis disease activity and greater impact on overall quality of life from health-related limitations and impaired ability to work.

Axial involvement and chronic low back pain from psoriatic arthritis can be caused by inflammatory back pain, resulting from autoimmune-induced joint inflammation, or mechanical back pain, caused by physical injury to the lumbar spine.

Both types of back pain are commonly seen in psoriatic arthritis, but are treated differently due to their different causes.

What Is an Autoimmune Disease?

Autoimmune disease happens when the body’s natural defense system can’t tell the difference between your own cells and foreign cells, causing the body to mistakenly attack normal cells. There are more than 80 types of autoimmune diseases that affect a wide range of body parts.

According to the classification criteria of the Assessment of SpondyloArthritis international Society (ASAS), inflammatory back pain typically lasts for three months or more with an insidious or unknown onset, begins in patients at an age younger than 40, improves with exercise but gets worse with rest, and causes increased pain at night.

Mechanical back pain, however, can have an onset at any age, although it is more common in middle-aged and older individuals, can be acute from a specific event that causes an injury, and often feels worse with movement but improves with rest. These symptoms can result from injury or damage to the lower back muscles, tendons, ligaments, discs, joints, or vertebrae.

Causes

Psoriasis is an autoimmune disease that often has a genetic link. People with autoimmune conditions tend to inherit genes that increase their risk of developing one, which can be triggered by stress, illness, infection, smoking, and other factors like diet and alcohol and drug use that cause inflammation throughout your body.

Psoriatic arthritis, especially axial involvement affecting the spine, has been linked to a specific gene marker in patients with psoriasis called HLA-B27. This gene is more often found in patients with psoriatic arthritis who have inflammatory back pain, which results from inflammatory cellular changes in the joints of the spine.

This causes a chronic cycle of inflammation and unbalanced bone remodeling, leading to bone loss and potential fusion of bones in the spine and sacroiliac joints. These changes may result from the mechanical strain exerted on the vertebrae from the inflamed tendon and ligament attachment sites that results from psoriasis.

Diagnosis

The prognosis for those diagnosed with psoriatic arthritis becomes worse the longer their condition goes untreated, so it is important to seek medical attention if you think you have symptoms of psoriatic arthritis.

Psoriatic arthritis symptoms typically occur after a diagnosis of psoriasis has been made, but occasionally symptoms of psoriatic arthritis can present before symptoms of psoriasis on the skin are present.

A physical exam combined with a review of your medical history, symptoms, and X-ray imaging are used to confirm a diagnosis of psoriatic arthritis and identify the affected joints. 

An X-ray of your spine is considered the gold standard for differentiating axial involvement of psoriatic arthritis from other degenerative or inflammatory conditions. Axial involvement of your spine should be assessed as soon as possible since axial involvement with psoriatic arthritis often requires more aggressive treatment.

MRIs can also give your doctor a clearer look at your cartilage and other parts of your affected joints. Blood tests that examine your erythrocyte sedimentation rate and levels of C-reactive protein can help confirm a diagnosis of psoriatic arthritis since these markers are typically elevated with this condition.

You may also have bloodwork that examines your rheumatoid factor to rule out a diagnosis of rheumatoid arthritis, an autoimmune type of arthritis that usually occurs symmetrically on both sides of the body.

Back pain associated with psoriatic arthritis can either be inflammatory or mechanical. A diagnosis is made with the following classification criteria, along with imaging results and laboratory tests.

Inflammatory back pain is typically characterized by:

  • Back pain lasting three months or more 
  • Patient age under 40
  • Unknown onset
  • Improved symptoms with exercise
  • Worsened symptoms with rest
  • Increased pain at night

Mechanical back pain is typically characterized by:

  • Any age, with a greater likelihood for middle-aged and older adults
  • Variable onset, often linked to acute aggravating factors that cause injury or damage
  • Improved symptoms with rest
  • Worsened symptoms with movement

Psoriatic Arthritis Doctor Discussion Guide

Doctor Discussion Guide Old Man

Treatment

Symptoms of psoriatic arthritis and related back pain can worsen over time if left untreated. Management of your condition is crucial for preventing disease progression and worsening of symptoms, which can significantly impact your quality of life and ability to complete your day-to-day activities.

Treatment options for managing your back pain from psoriatic arthritis include:

  • Over-the-counter pain (OTC) medication: OTC nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help decrease pain.
  • Exercises: Stretches and exercises can help ease pain, improve range of motion and joint mobility, and increase the strength of the muscles surrounding your spine.
  • Prescription medication: Medications may be prescribed to slow disease progression, including disease-modifying antirheumatic drugs (DMARDs) and biologics like TNF inhibitors.
  • Rehabilitation: Your doctor may refer you to physical therapy to improve the mobility of your joints, increase the strength and flexibility of surrounding muscles, and apply therapeutic modalities to alleviate pain, stiffness, and swelling.

According to the recommendations from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), inflammatory back pain is best treated with physical therapy, NSAIDs, and biologics and DMARDs to decrease the autoimmune response. Mechanical back pain is best treated with rest for acute cases, followed by physical therapy, self-management, stress management, and NSAIDs if necessary.

Coping

Maintaining healthy lifestyle habits can help manage your psoriatic arthritis symptoms by decreasing inflammation throughout your body and promoting a healthy environment for healing.

Tips for a healthy lifestyle include:

  • Prioritizing getting enough sleep at night—at least seven to eight hours—to promote healing
  • Eating a healthy diet and managing a healthy weight
  • Staying adequately hydrated
  • Maintaining a positive attitude and learning how to cope with and manage stress
  • Exercising and staying active

Summary

Psoriatic arthritis is an inflammatory form of arthritis that develops in some people with psoriasis, an autoimmune skin disease that causes skin cells to build up and form plaques. The condition can affect the lumbar spine, or lower back, and cause pain in the area. Back pain caused by psoriatic arthritis can be inflammatory, which has an unknown onset, or mechanical, which is caused by an injury. The two types of pain will feel different and are accompanied by different symptoms.

A Word From Verywell

If you have been suffering from back pain for more than three months, it is important to seek medical attention to determine a diagnosis and get the treatment you need to manage your symptoms. Psoriatic arthritis can worsen if left untreated and progress to more systemic signs of inflammation throughout your body. 

Frequently Asked Questions

  • How does psoriatic arthritis back pain feel?

    Back pain from psoriatic arthritis can feel like an aching pain and increased pressure in your back from joint stiffness and inflammation that develops.

  • Where does your back hurt with psoriatic arthritis?

    Psoriatic arthritis can occur anywhere along the spine, but is most common in the lumbar spine, or low back.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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