Neck pain due to psoriatic arthritis (PsA), known as psoriatic spondylitis, may respond to medications, including disease-modifying antirheumatic drugs, exercise therapy, and certain lifestyle changes.

Neck pain can affect people with a specific type of PsA called psoriatic spondylitis. Some people with PsA may also experience a reduction in their neck’s range of motion.

If PsA is causing stiffness and pain in your neck, you can work with your doctor to determine an appropriate treatment plan. These treatments and exercises may help relieve PsA neck pain.

PsA is an inflammatory disease that affects the joints and the spots where bones connect with tendons and ligaments. Inflammation in these areas causes swelling, pain, and stiffness.

Psoriatic spondylitis is one of five PsA subtypes. It results in inflammation in the discs between the spinal vertebrae.

Spondylitis can make it difficult and painful to move your neck. It can also cause pain and stiffness in the lower back or pelvis, as well as fusion in the sacroiliac joints of the pelvis that connect it to your lower spine.

Spondylitis occurs in up to 20% of people with PsA. Symptoms of spondylitis may include:

  • lower back pain
  • back and neck pain that worsens when you’re sedentary
  • back and neck pain that disrupts your sleep
  • back and neck pain that improves with exercise
  • hip and buttock pain from inflammation in the sacroiliac joints
  • morning stiffness in the back that lasts for a half hour or more and improves with a warm shower

People with PsA may have symptoms of psoriasis for up to 10 years before receiving a spondylitis diagnosis.

Doctors have several ways to diagnose psoriatic spondylitis:

  • Blood tests: Your doctor can order blood tests to rule out other diseases that can cause neck pain, such as rheumatoid arthritis.
  • Imaging tests: X-rays, MRI scans, and CT scans can give doctors a look at the bones and joints of your spine.
  • Medical history: Your doctor may ask detailed questions about your symptoms, family history, and medical history to help determine whether you have spondylitis.
  • Physical exam: Your doctor can perform a physical exam to look for signs related to spondylitis, such as a rash or nail pitting.

PsA is a lifelong condition with no known cure. Several treatments can help improve neck pain associated with spondylitis by reducing inflammation or targeting an over-reactive immune system.

Medications a doctor may recommend include:

  • nonsteroidal anti-inflammatory drugs
  • disease-modifying antirheumatic drugs, such as sulfasalazine, methotrexate, and JAK inhibitors
  • biologic drugs, such as TNF blockers, IL-17 inhibitors, or IL-23 inhibitors

Lifestyle changes

Lifestyle changes can also help manage PsA neck pain. You can try:

  • Exercise: Maintaining an active lifestyle can help ease PsA symptoms. Doctors usually recommend low impact exercise, such as yoga, swimming, or tai chi.
  • Hot or cold therapy: A hot shower, bath, or heating pad right after waking up and just before bedtime can soothe pain and stiffness. Using an ice pack for 10 minutes at a time can also help calm inflammation and decrease nerve pain.
  • Quitting smoking, if you smoke: Smoking increases your risk of PsA and can make the condition more severe. Quitting may help improve your symptoms and decrease other inflammatory risk factors like cardiovascular disease.
  • Maintaining a moderate weight: Having overweight or obesity can place an additional stress on your joints and potentially increase your pain and body inflammation. A doctor can determine if losing weight should be part of your treatment for PsA neck pain.
  • Making your bed more comfortable: The right mattress and a pillow with good neck support can help keep your body in a comfortable position throughout the night. Look for a mattress that’s firm and supportive but not too hard.
  • Using an ergonomic chair: A high backed chair with a firm seat, armrests, and adjustable recline can help you maintain good posture and relieve weight on the spine. It’s still a good idea to get up and stretch frequently during the workday.

Regular exercise can be key to managing PsA neck pain. Before starting any exercise program, check with your doctor to make sure it’s safe for you.

The following exercises may help with PsA neck pain:

Posture stretch

  • Stand with your back, shoulders, buttocks, and heels against or close to a wall.
  • Tuck in your chin and push your head back. Stretch your body tall without lifting your heels.
  • Slowly lift your arms out toward the sides and up over your head. Touch the wall with the back of your hands the whole time.
  • Slowly lower your arms.
  • Repeat the exercise five times.

Trunk side stretch

  • Stand against a wall.
  • Lean to the side and slide your right arm along the outside of your right leg as far down as possible until you feel a stretch. Keep your buttocks and shoulders touching the surface.
  • Gently release.
  • Do the same thing on the opposite side.
  • Repeat the exercise five times on each side.

Neck rotation

  • Sit up tall in a chair. Keep good posture, with your feet flat on the floor.
  • Grip the edges of your chair seat, turn your head to look to one side as far as possible, and keep your shoulders facing forward.
  • Repeat the exercise on the other side.
  • Repeat three times.

Supine retraction

  • Lie on your back with your head in a neutral position.
  • Use your fingers to gently press your chin downward and your head into your resting surface until you feel a stretch in the back of your neck.
  • Repeat up to 10 times.

Prone head lift

  • Lie face down with your forearms flat on the ground and your elbows bent at 90-degree angles beneath your shoulders. If you do yoga, this position is similar to the sphinx pose.
  • Release all tension from your neck. Let your head hang down so your chin is near your chest.
  • Raise your head as your chin tucks in and try to look toward the ceiling. Hold for 5 seconds. Slowly release.

For more PsA neck pain exercises, check out the guides from the North American Spine Society.

Neck pain is a common symptom of psoriatic spondylitis. Staying active and making lifestyle changes can help you manage PsA neck pain. Your doctor may also recommend additional treatments, including medication for PsA.