If you’ve been diagnosed with psoriatic arthritis (PsA), you may have experienced some form of back pain.

Up to 70% of PsA patients may experience axial symptoms during the course of their disease.1

Scientists are yet to discover the exact link between PsA and spinal problems, but it’s thought to lie in the fact that the conditions are all rooted in defects in the immune system, which can cause it to go rogue and spread inflammation through the body.2 The two back conditions that most commonly affect people with PsA are spondylitis and sacroiliac joint pain (Sacroiliitis).2 If you're anything like us then wrapping your tongue around the words can feel like a challenge in itself, let alone actually trying to understand what they can actually do to your spine! But don't worry - we're going to bust through the science to reveal exactly what the conditions can do to your joints.

Spondylitis

Spondylitis occurs in approximately 20% of people with PsA, and leads to joint inflammation in two main areas: between the pelvis and spine, and between the spine’s vertebrae.3 In some cases, ‘bony overgrowth’ can cause two or more vertebrae to grow together, or fuse, causing stiffness which makes motion difficult and causes intense pain. Although most common in the spine, spondylitis can also occur in the joints of the arms, hips, legs, or feet.

People with spondylitis in their spine tend to be older and have longer PsA disease duration4, although this is another link that hasn’t fully been explained. So how do you spot suspected spondylitis? Symptoms can often include back pain which is alleviated by exercise, but doesn’t get better with rest; higher levels of stiffness and back pain in the mornings and evening, and pain in the ligaments and tendons of the back.3

Sacroiliac joint pain

Approximately one-third of people with PsA have sacroiliitis, and it’s largely found to be more common in women.5 Just like spondylitis, the condition is essentially caused by inflammation of specific joints, in this case it’s the sacroiliac joints, which are located in your lower back and sit on each side of your spine. Their main job is to carry the weight of your upper body when you stand or walk, and shift that load to your legs.

Interestingly, sacroiliitis can often occur in just one of the two joints, so if you’re experiencing recurring pain on one side of your lower back then it’s really important to raise this with your physician, as it can be a key indicator to help diagnose the condition.5

Because of the purpose of the joints it affects, sacroiliitis is aggravated by simple movements such as standing, walking, sitting for a long time (e.g. driving a car) or changing position while lying down in bed. People with the condition often say that it’s particularly painful when they move from a seated to a standing position, so look out for times when the transition from a sitting to a standing position is particularly painful.5

Phew! A whistle stop tour of the two most common back problems linked to PsA complete. If you are experiencing unusual back pain or stiffness then make sure you speak to your physician, and check out our list of simple life hacks to make daily tasks that little bit easier.

References

1Feld J et al. Axial disease in psoriatic arthritis and ankylosing spondylitis: a critical comparison. Nature Reviews Rheumatol. 2018;14(6):363-371

2Website: Arthritis Foundation. Arthritis and Diseases that Affect the Back. Last accessed 25 July 2019 http://www.arthritis.org/about-arthritis/where-it-hurts/back-pain/causes/back-arthritis.php

3Website: Spondylitis Association of America. Overview of Psoriatic Arthritis. Last accessed 25 July 2019 https://www.spondylitis.org/Psoriatic-Arthritis

4Baraklios, X et al. The involvement of the spine in psoriatic arthritis. Clin Exp Rheumatol 2015; 33 (Suppl. 93):S31-S35. http://www.clinexprheumatol.org/article.asp?a=9845

5Website: Spine Health. All About Sacroiliitis. Last accessed 25 July 2019 http://www.spine-health.com/conditions/sacroiliac-joint-dysfunction/all-about-sacroiliitis

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