What to Know About Psoriatic Arthritis and Back Pain

PsA develops in about 20% of people with psoriasis, most commonly between the ages of 30–55 years old. It results from an autoimmune reaction in which your immune system attacks healthy cells in your joints.

This autoimmune reaction leads to inflammation that can irritate pain receptors and send pain messages to your brain. It can also cause symptoms like stiffness and swelling.

When this inflammation affects the small joints between the vertebrae in your spine, it’s known as spondylitis. This affects about 1 in 5 people with PsA, according to the Spondylitis Association of America.

PsA can also affect the joints between your vertebrae and pelvis, known as the sacroiliac (SI) joint. Inflammation in this region is called sacroiliitis, and it occurs in 25–50% of people with PsA.

PsA that affects your spine is called axial PsA.

Typical features of PsA-related back pain include:

• gradual onset
• improvement with exercise
• pain at night

Your pain might develop in your:

• neck
• lower back
• joints between your pelvis and spine (SI joints)

PsA most often also causes pain in other joints, such as the small joints in your hands or feet.

Other features of back pain from PsA can include:

• stiffness in the morning
• no improvement with rest
• symptoms that flare up for days to weeks and then get better for some time

Back pain is common among people with PsA, but it’s also common in the general population.

Back pain can be either mechanical or inflammatory. Mechanical back pain results from repeated stress on your spine, such as after carrying heavy objects for many years.

But inflammatory back pain is caused by an immune reaction. It’s a feature of some types of arthritis, such as PsA or rheumatoid arthritis.

Doctors can identify whether your back pain has an inflammatory or mechanical cause with imaging like X-rays or MRI scans.

A doctor may also order a blood test to look for inflammatory markers in your blood or genes linked to psoriasis.

Having inflammatory changes to your spine alone doesn’t mean you have PsA. Ankylosing spondylitis (AS) is another type of arthritis that commonly causes inflammatory back pain.

Doctors can look for other clues that your pain is likely due to PsA, such as:

• a previous psoriasis diagnosis
• a family history of psoriasis or PsA
• symptoms in other joints like your hands and feet
• the HLA-B27 gene, which is found in 20% of people with spinal PsA but up to 90% of people with AS

Treatment for PsA involves making lifestyle changes and taking medications.

Lifestyle changes that may help minimize your disease activity include:

• attending physiotherapy or occupational therapy
• staying physically active with low impact exercises like swimming or yoga
• quitting smoking if you smoke
• losing weight if you have overweight or obesity
• lowering your alcohol intake

The first type of medication doctors usually recommend is nonsteroidal anti-inflammatory drugs (NSAIDs). These medications are available as tablets, creams, or gels.

If NSAIDs don’t help reduce your symptoms, a doctor may recommend other medications, such as:

• steroid injections
• traditional disease-modifying antirheumatic drugs
• biologics such as tumor necrosis factor inhibitors
• bisphosphonates to strengthen your bones

You may need surgery if your joints become severely damaged.

PsA usually doesn’t affect your life expectancy. The outlook for people with PsA is highly variable. Some people only ever develop mild joint and skin symptoms, whereas others develop severe symptoms that drastically affect their quality of life.

People who have multiple joints affected tend to have a worse outlook.

In a 2018 study, researchers found that axial PsA was associated with more significant disease activity and a greater effect on quality of life than PsA affecting other areas.

Here are some frequently asked questions people have about PsA and back pain.

How common is back pain in people with psoriatic arthritis?

Experts generally consider back pain a common symptom of PsA. Anywhere from 25–70% of people with PsA have inflammatory pain around their spine or pelvic bone.

Can low back pain be an early indication of psoriatic arthritis?

Back pain can be the first or among the first symptoms for people with PsA. In some people, imaging tests might show evidence of inflammatory changes around the spine without back pain.

Are the effects of psoriatic arthritis on the spine visible on an X-ray?

X-rays remain one of the main tests doctors use to visualize inflammatory changes in your spine related to PsA. MRI is another common tool.

Back pain is a common symptom of PsA. Many people with back pain also have symptoms in other joints, such as the small joints in their hands or feet.

The outlook for people with PsA varies significantly. A doctor can help recommend lifestyle changes and medications that may help relieve your symptoms.