About Psoriatic Spondylitis

Spondylitis (also called spondyloarthritis) refers to a group of inflammatory conditions that affect the spine. The most common type is ankylosing spondylitis, but there are other forms that have links to other inflammatory diseases, such as psoriasis.

According to the Spondylitis Association of America, 20 percent of people with psoriatic arthritis (PsA) will develop psoriatic spondylitis. This means that you have PsA with spinal involvement.

If you currently have psoriasis or PsA, and are experiencing chronic back pain, see your doctor for a diagnosis. Detecting this spinal disease early can reduce the risk of potentially debilitating complications.

Spondylitis can cause pain, swelling (inflammation), and stiffness in your spine. Psoriatic types can affect any part of the spine from the neck down to your lower back. In some cases, you may experience pelvic pain and inflammation in the sacroiliac joints; this damage is called sacroiliitis.

The symptoms of psoriatic spondylitis tend to be worse upon waking up in the morning, or after long periods of inactivity. You may notice the pain and swelling getting worse over time, as well as fatigue.

If you have psoriatic spondylitis, you’ve likely already been diagnosed with psoriasis or PsA, or both. Symptoms of psoriasis may not necessarily occur in the same areas of the body — or at the same time — as joint pain.

Psoriasis is an inflammatory skin disease that causes widespread scaly rashes. Also called skin lesions or plaques, these rashes form as a result of increased skin cell turnover. While skin cells naturally mature and fall within 30 days, psoriasis accelerates this cycle to just 3 to 4 days.

It’s estimated that 30 percent of people with psoriasis develop PsA, with 20 percent developing spondylitis. Like other types of arthritis, PsA affects your joints. In some cases, PsA symptoms may develop up to 10 years after psoriasis.

If you develop symptoms of arthritis and already have psoriasis, your doctor will likely diagnose you with PsA. Early signs of PsA occur in smaller joints, such as those in your hands and feet. It may progress to your elbows, knees, and ankles. Eventually, PsA may affect your spine.

The underlying inflammation of psoriatic spondylitis can lead to permanent joint damage. If left untreated, it may also cause bones in your spine to fuse together, leading to the following complications:

• reduced flexibility
• permanent hunched-over spinal posture
• decreased mobility
• increased stiffness and pain

Other possible complications may include:

• osteoporosis of the spine, and possible spinal fractures
• inflammatory bowel disease
• uveitis, a type of inflammation of the eye
• heart inflammation

While there’s a link between both psoriasis and PsA with psoriatic spondylitis, the exact cause of spondylitis is unknown.

Like other types of autoimmune diseases, psoriatic conditions develop as a result of your body mistaking healthy cells and tissues for invaders. Your immune system then attacks them.

Autoimmune diseases tend to run in families. It’s possible to develop more than one type of autoimmune condition.

For spondylitis, the average age of onset is between 17 and 45 years old. However, it’s possible to develop these conditions at any age.

Certain genetic markers may also increase your risk. If you have a gene called HLA-B27, you may be at a greater risk for developing spondylitis.

See your doctor if you have PsA and have back symptoms. It’s estimated that some people who have PsA have spondylitis, but they may not receive an official diagnosis for as long as 10 years.

To diagnose this condition, your doctor will first consider your medical history. They will ask you about personal or family history of psoriasis, PsA, or other autoimmune conditions.

Your doctor will ask about your symptoms, when they occur, and how long you’ve had them. They will also conduct a physical exam to look for joint inflammation and psoriasis lesions.

A diagnosis of psoriatic spondylitis also depends on what’s found in imaging tests, such as X-rays. In particular, your doctor will look for changes along the sacroiliac joints in the pelvis. Magnetic resonance imaging (MRI) may also be used to capture clearer images.

Treatment for psoriatic spondylitis involves a combination of medications, lifestyle changes, and possible surgery.

Medications may include one or more of the following:

• corticosteroid injections to decrease inflammation in cases where joint symptoms and damage aren’t widespread
• disease-modifying antirheumatic drugs (DMARDs) for widespread joint pain and inflammation
• nonsteroidal anti-inflammatory dugs (NSAIDs) to alleviate joint inflammation and pain

Your doctor may also recommend lifestyle adjustments, such as:

• regular exercise to reduce pain and swelling and increase mobility
• hot and cold therapies for pain
• an anti-inflammatory diet
• physical therapy to help with posture and mobility
• quitting smoking

While there’s no cure for psoriatic spondylitis, these treatments and lifestyle changes can help reduce further inflammation and joint damage. Subsequently, you may experience fewer symptoms.

Surgery is an option in cases where psoriatic spondylitis has caused significant damage and reduced your quality of life. If your doctor recommends surgery, the process involves replacing the entire joint(s) with those made out of ceramic, metal, or plastic.

Psoriatic spondylitis is a type of inflammation of the spine. Unlike other types of spondylitis, this form is seen in people with psoriasis and PsA.

It’s possible to have both psoriasis and PsA for years before developing spondylitis. It’s important to report any ongoing or worsening back or neck pain to a doctor, so they may be able to diagnose this condition sooner rather than later.

There’s no cure for psoriatic spondylitis, so prompt treatment and management is important to help reduce damaging inflammation. Surgery may be a last resort for spinal damage.