How Does Psoriatic Arthritis Affect the Back and Spine?

Reviewed by: HU Medical Review Board | Last reviewed: July 2022

Psoriatic arthritis (PsA), the chronic inflammatory arthritis associated with psoriasis, can affect any joint in the body. This includes the back and spine. When the spine is affected in people with PsA, it is called axial disease, while pain in the arm and leg joints is called peripheral disease.1

What are the symptoms?

When PsA affects the spine, people may have lower or upper back pain and stiffness. This pain and stiffness is often worse in the morning or after periods of rest. Pain may be throbbing at the affected joints.1

PsA in the back and spine can show up as one of the following:1,2

  • Spondylitis – Inflammation in the joints between the vertebrae. This can cause reduced range of motion and involves the lower or upper back or neck.
  • Sacroiliitis – Inflammation in the joints between the spine and the pelvis. This can occur on only one side of the body (asymmetrical) and causes lower back pain.

Normal back pain is different from PsA-associated back pain. It usually occurs after injury, strain, or overuse. With PsA-associated axial disease, the pain comes and goes without any clear injury or trauma.1

Here are some signs that indicate your back pain may be caused by PsA:1

  • Pain wakes you up at night.
  • Pain gets better with exercise and worsens after periods of not moving.
  • Stiffness and pain is worse first thing in the morning.

Who is affected?

About 7 to 32 percent of people with PsA experience back and spine issues. When PsA affects the back and spine, it is usually a later-stage symptom of the disease. But this is not always the case. Back and spine pain may also show up many years before an official diagnosis is made. Axial disease is also more common in men.1,2

Spondylitis shares similarities with ankylosing spondylitis. Both are inflammatory diseases that may have a link to the HLA-B27 gene. This is a gene that makes people more likely to develop several rheumatic diseases.1,3

How is it diagnosed?

Axial disease is often diagnosed with the use of X-ray and magnetic resonance imaging (MRI). An MRI scan allows doctors to spot bone erosions, changes in the spine, or abnormal bone growth between the vertebrae in your spine. Blood tests can also show signs of inflammation.1

How is PsA in the lower back and spine treated?

For mild cases of PsA and minor back pain, non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain and swelling. Steroid injections can be used as well.1-4

For moderate to severe axial disease, drugs that target joint disease in PsA can reduce symptoms and prevent disease progression. Recommended treatment options include:1-4

  • Disease-modifying anti-rheumatic drugs (DMARDs) – These drugs help calm your symptoms, slow down the disease, and prevent or slow joint damage.
  • Biologic drugs – These drugs fight inflammation. They are often prescribed for PsA.
  • Anti-tumor necrosis factor (TNF) agents – TNFs create inflammation in the body. Anti-TNF agents target TNFs to reduce inflammation. They are a treatment option if DMARDs or biologics are not working.

Physical and occupational therapy can be a helpful complementary treatment approach to medicines. Physical therapy can help protect the involved joints and maintain function. It may include exercises, stretching, heat/cold therapy, and massage therapy.1-4

Treatment for PsA in the back and spine may be different from treatment for other PsA symptoms. If you have PsA and start to experience back or spine pain, talk to your doctor about your treatment options. They can recommend a combination of drug treatment with non-drug therapies like regular exercise and physical therapy.1,4

Healthy lifestyle habits for back and spine pain

Adopting a healthy lifestyle can help with back and spine pain. Try to add some of these into your everyday routine:3,4

  • Eat a balanced diet. While diets cannot prevent PsA from developing or treat it directly, eating certain foods can help manage inflammation. The Mediterranean diet is a great diet if you have PsA. It is full of healthy fats, lean protein, colorful fruits and vegetables, and whole grains. Avoid foods that cause inflammation, like red meats, processed foods, alcohol, and anything high in sugar and trans fats.
  • Consider losing weight. If you are overweight, losing weight can help ease pressure and inflammation in your joints.
  • Exercise regularly. Regular exercise is important to help maintain joint mobility and function in people with axial disease. It can also ease pain and discomfort. But make sure to take time to rest, and do not overdo it!
  • Try acupuncture. Acupuncture is an ancient Chinese medicine that has been shown to help with chronic pain in some people.
  • Use heat and cold. A warm bath can help with sore joints. A cold compress can help reduce swelling.
  • Stop smoking. Smoking can increase PsA disease progression and can impact how well PsA treatment works. If you smoke, take steps to quit.
  • Manage stress. Stress can trigger inflammation in the body. Take steps to reduce stress in your life. Try meditation, gentle movement like yoga or tai chi, or talk therapy.

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