Psoriatic Spondylitis: Symptoms, Causes, Diagnosis, Treatment

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

Symptoms

Research published in 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
• 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. If both of your parents have PsA, you have a 50/50 chance of getting it.
• Age: While PsA can affect anyone of any age, new diagnoses tend to appear in adults between 30 and 50.
• Obesity: Obesity increases inflammation. This increases the severity of psoriatic disease plus the risk of developing it in the first place.
• Stress: Stress is known to trigger psoriatic arthritis symptoms. Relaxation techniques such as massage, yoga, and meditation can help.

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.

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, corticosteroid injections may help by bringing down inflammation. 

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 permanently curved (kyphosis). Exercise can also reduce the 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 can make you slouch, causing more strain on the spine. 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 and routine exercise can help reduce inflammation and stress on the spine while boosting energy.

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's 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.