Back discomfort frequently accompanies psoriatic arthritis as a prevalent manifestation, primarily due to the spinal joints’ inflammation. While over-the-counter medications are often turned to for pain mitigation, additional forms of intervention include steroid injections and engaging in physical therapy.
Psoriasis, an autoimmune disease, is characterized by swollen, patchy skin areas. For some individuals with psoriasis, it progresses into psoriatic arthritis (PsA), which not only has the potential to induce back pain but can also affect various other joints such as those in the:
- fingers,
- knees,
- ankles,
- elbows, and
- feet.
It’s possible for back pain to emerge either as an isolated issue or in tandem with joint inflammation elsewhere in the body. Notably, PsA can arise even in the absence of the characteristic skin manifestations associated with psoriasis.
Psoriatic arthritis (PsA) affects approximately 20% of individuals with psoriasis, predominantly emerging in the 30 to 55-year age range. This condition stems from an autoimmune response wherein the immune system mistakenly assaults healthy cells within the joints.
The resultant autoimmune reaction triggers inflammation that can aggravate pain receptors and transmit pain signals to the brain, causing symptoms such as stiffness and swelling.
Notably, when this inflammation invades the tiny articulations between the spinal vertebrae, it manifests as spondylitis. The Spondylitis Association of America acknowledges that around 20% of PsA sufferers experience this complication.
PsA is also known to target the joints where the spine and pelvis meet, termed the sacroiliac (SI) joints. This specific inflammation, known as sacroiliitis, occurs in 25–50% of individuals with PsA.
The characteristic pain associated with PsA-related back discomfort typically presents with a slow onset, with physical activity often bringing respite, and intensification of pain during the night. Areas commonly affected by pain include the neck, lower back, and SI joints. PsA is also recognized for frequently inducing pain in other joints, including those in the hands and feet.
Additional symptoms peculiar to PsA’s impact on the back include stiffness upon waking and persistent symptoms unrelieved by rest, with episodes of heightened discomfort that can last from days to weeks, interspersed with periods of remission.
Are you wondering if your back pain is due to psoriatic arthritis (PsA)? While back pain is a common symptom of PsA, it is also prevalent among the general population. There are two types of back pain: mechanical and inflammatory. Mechanical back pain often results from repetitive strain on the spine, while inflammatory back pain is related to an immune response and is associated with conditions like PsA or rheumatoid arthritis.
To determine the cause of your back pain, doctors may use imaging techniques such as X-rays or MRI scans. Additionally, blood tests can be ordered to detect inflammatory markers or genes linked to psoriasis. However, spinal inflammation alone is not enough to diagnose PsA; it could also indicate ankylosing spondylitis (AS), another type of arthritis that causes inflammatory back pain.
Other factors that may suggest your back pain is related to PsA include a previous psoriasis diagnosis, a family history of psoriasis or PsA, symptoms in other joints, and the presence of the HLA-B27 gene.
To manage back pain caused by psoriatic arthritis, a combination of lifestyle changes and medication is recommended. Lifestyle modifications that can help lessen disease activity include participating in physiotherapy or occupational therapy, staying active with low-impact exercises, quitting smoking, losing weight, and reducing alcohol intake.
For medication, doctors typically first suggest nonsteroidal anti-inflammatory drugs (NSAIDs), available in various forms. If NSAIDs prove ineffective, other options include steroid injections, traditional disease-modifying antirheumatic drugs, biologics, and bisphosphonates to fortify the bones.
The prognosis for individuals with psoriatic arthritis (PsA) and associated back pain is generally not linked to a reduction in life expectancy. However, the course of PsA can differ greatly from person to person. Many experience only minor symptoms impacting their joints and skin, while others face more severe manifestations that can profoundly impact their day-to-day wellbeing.
Those with multiple joints involved may experience more challenging outcomes.
Insights from a 2018 research study suggest that axial PsA, which targets the spine and sacroiliac joints, correlates with elevated levels of disease activity and a more pronounced impact on one’s quality of life compared to instances where PsA affects other body regions.