An Overview of Psoriatic Spondylitis

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Psoriatic spondylitis (a.k.a. axial disease) 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.

psoriatic spondylitis common symptoms
Illustration by Brianna Gilmartin, Verywell

Symptoms

Research published in the Clinical and Experimental Rheumatology found that up to 40% of people with PsA have spine involvement. 

Spine involvement usually means there is inflammation of the spine and SI joints that support it, which are located in the pelvis. 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 magnetic resonance imaging (MRI) and X-ray. 

Symptoms of psoriatic spondylitis may include:

  • Back pain
  • Pain and swelling in other joints (including hips, knees, shoulders, ankles, feet, elbows, hands, and wrists)
  • Dactylitis (the sausage-like swelling of the toes and fingers)
  • Reduced range of motion of the low back, spine, and pelvis
  • Psoriasis
  • Chronic fatigue
  • Osteoporosis
  • Endocarditis (inflammation of the heart valve)
  • Uveitis (inflammation of the pigmented part of the eye)

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 mutation of the human leukocyte antigen B27 (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, according to a 2016 study in the Annals of Rheumatic Diseases. But not everyone with this gene will develop PsA.

Other risk factors include:

  • Family history: Many people with PsA have another family member with the condition, usually a parent or sibling. In fact, if both of your parents have psoriatic arthritis, you have a 50/50 chance of getting it yourself.
  • Age: While PsA can affect anyone of any age, new diagnoses tend to appear in adults between ages 30 and 50.
  • Obesity: Obesity increases the level of inflammation in the body. While this certainly increases the severity of the psoriatic disease in people who have it, there is also evidence that it increases the risk of developing the disease in the first place.
  • Stress: Stress is known to trigger psoriatic arthritis symptoms by releasing the stress hormone cortisol into the bloodstream. This can incite an autoimmune response and lead to symptom flares.

Diagnosis

A diagnosis of psoriatic spondylitis starts with a physical examination and a review of your 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.

It is important to note that no blood or imaging tests can definitively diagnose psoriatic arthritis. The diagnosis requires clinical expertise and the exclusion of all other possible causes of the symptoms.

Other medical conditions that mimic psoriatic arthritis include osteoarthritis, gout, rheumatoid arthritis, and reactive arthritis. It is vital that a differential diagnosis is conducted to ensure that the correct treatment is used.

Treatment

Minor pain, stiffness, and other symptoms of psoriatic spondylitis can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs). These include over-the-counter NSAIDs like Advil (ibuprofen) and Aleve (naproxen), and prescription NSAIDs like Celebrex (celecoxib).

Additionally, corticosteroids may help by 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 alleviating inflammation and pain, preventing joint deformity, and halting disease progression. This includes using disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate or biologic drugs like Cosentyx (secukinumab). 

Other biologics include tumor necrosis factor (TNF) inhibitors like Humira (adalimumab) and Enbrel (etanercept), which block the substance that instigates the inflammatory response.

Physical and occupational therapy are also recommended to protect joints and maintain the optimal range of motion. Lifestyle changes can also help, including:

  • Exercise: Stretching may keep the spine from being stiff and going into a permanent curvature (known as kyphosis). Exercise can also reduce stress that triggers a psoriatic flare.
  • Smoking cessation: Smoking can promote joint damage in the spine. Quitting can slow disease progression even if you are a lifetime smoker.
  • Improved 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 permanent slumped appearance.
  • Weight loss: Carrying excess weight invariably affects your posture. An informed weight loss plan, along with routine exercise, can help alleviate stress on the spine while improving energy levels and reducing inflammation.

A Word From Verywell

Living with psoriatic spondylitis can be stressful, so it is important to take the steps needed to manage your symptoms and maintain a good quality of life. By being proactive, you may be able to slow disease progression and avoid treatments that are typically more difficult to manage. It is important to seek support from friends, family, and medical professionals. Also consider joining a support group to connect with others in your shoes; the group locator offered by CreakyJoints is a good place to start.

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Article Sources

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  2. Baraliakos X, Coates L, Braun J. The involvement of the spine in psoriatic arthritisClin Exp Rheumatol. 2015;33(Suppl. 93):S31-S35.

  3. Alexander W. Psoriatic Spondyloarthritis Burden is Similar to Ankylosing Spondylitis. Rheumatology Network. Published 2017.

  4. Jadon D, Sengupta R, Nightingale A et al. Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritisAnn Rheum Dis. 2016;76(4):701-707. doi:10.1136/annrheumdis-2016-209853

  5. New York University Langone Health. Lifestyle Changes for Psoriatic Arthritis. Published 2019.

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