An Overview of Psoriatic Spondylitis

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Psoriatic spondylitis is a type of psoriatic arthritis (PsA) where inflammation affects the spine and causes movement problems in the neck, low back, pelvis, and sacroiliac (SI) joints. This type of PsA may also cause joint pain in the arms, legs, hands, and feet.

Symptoms

Research reported in the Clinical and Experimental Rheumatology finds up to 40 percent of people with PsA have spine involvement. Psoriatic spondylitis is sometimes called axial disease.

Spine involvement usually means there is inflammation of the spine and SI joints. The SI joints are located in the pelvis and they support the support the spine. The joints themselves are supported by the ilium bones (uppermost and largest bones of the hips) of the pelvis.

Psoriatic spondylitis is often asymmetrical, meaning it affects only one side of the body. Spine involvement causes inflammatory low back pain and the inflammation can be seen on imaging studies, including MRIs and X-rays. 

Symptoms of psoriatic spondylitis may include:

  • Back pain
  • Pain and swelling in other joints, including hips, knees, shoulders, ankles, feet, elbows, hands and wrists
  • Swelling of the toes and fingers, a condition called “sausage fingers”
  • Reduced range of motion and stiffness of the low back, spine, and pelvis
  • Osteoporosis
  • Chronic fatigue
  • Inflammation of the heart valve
  • Inflammation of the eyes, including pain and redness
  • Psoriasis skin rash
The Signs and Symptoms of Psoriatic Arthritis

Causes

PsA of the spine shares similarities with ankylosing spondylitis, another type of inflammatory arthritis primarily affecting the spine and large joints. Both of these conditions are autoimmune diseases caused by the HLA-B27 gene. HLA-B27 is the gene that predisposes people to several autoimmune diseases.  

There are other genes associated with PsA but HLA-B27 is the highest predictor of this condition. But not everyone with this gene will develop PsA.

Other Risk Factors

  • Psoriasis: Having psoriasis is another strong risk factor for PsA. Psoriasis is an inflammatory skin disease that causes skin to regenerate too quickly, resulting in red patchy skin with silvery scales.
  • Family history: Many people with PsA have another family member with the condition, usually a parent or sibling.
  • Age: While PsA can affect anyone of any age, new diagnoses tend to appear in adults between ages 30 and 50.

Diagnosis

A diagnosis of psoriatic spondylitis starts with a physical examination, including skin symptoms, and looking at a person’s medical history. The doctor may request X-rays or an MRI of the spine. X-rays generally look for abnormalities of the spine and sacroiliac joints. An MRI (magnetic resonance imaging) can offer a closer look at the joints.

Bloodwork can determine if someone carries the HLA-B27 gene. The presence of this gene, along with imaging and symptoms, generally confirms a diagnosis.

Treatment

Minor pain, stiffness and other symptoms of psoriatic spondylitis can be managed with NSAIDs (non-steroidal anti-inflammatory drugs). Additionally, corticosteroids may help with bringing down inflammation and reducing pain. Some are available in pill form or as a cream and can be prescribed by a doctor. Others are available as an injection and can only be administered by a doctor.

For moderate to severe disease, treatment is aimed at targeting inflammation, reducing symptoms, preventing deformities, and halting disease progression. This includes anything from disease-modifying anti-rheumatic drugs (DMARDs), i.e. methotrexate and biologic DMARDs, i.e. Cosentyx. Other biologics are tumor necrosis factor (TNF) inhibitors, such as Humira and Remicade. TNF is a chemical in the body that produces inflammation.

Physical and occupational therapy are also recommended for protecting joints maintaining function and range of motion.

Some lifestyle changes that lessen the pain of psoriatic spondylitis include:

  • Exercise: Stretching may keep the spine from being stiff and going into a permanent curvature.
  • Not smoking: Smoking can promote joint damage in the bones of the spine. Not smoking will reduce the effect of inflammation on the spine.
  • Good posture: Pain makes a person want to bend over, causing more strain to the spine. Practicing good posture can keep the spine from taking on a slumped appearance.
Treatment Recommendations for Psoriatic Arthritis

A Word From Verywell

Living with psoriatic spondylitis can be stressful, so it is important for people with this condition to take the steps necessary to manage their symptoms and maintain a good quality of life. It is also important to educate themselves about their illness, symptoms, and treatment needs. Moreover, they should take a proactive role in living a healthy lifestyle. Last, it is vital to seek out support and avoid people and things that cause stress and negatively affect health.

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