An estimated 30% of patients with psoriasis go on to develop psoriatic arthritis (PsA), a type of inflammatory arthritis that can affect joints throughout the body. One particular spot which psoriatic arthritis can affect is the lumbar spine (lower back). VeryWellHealth shared a helpful guide to the relationship between PSA and back pain, including potential symptoms to look out for, how and why back pain happens, the diagnostic process, and where to go from there. Check out the summaries below to learn more.

Psoriatic Arthritis (PsA)

Of course, the first step is understanding exactly what psoriatic arthritis is. As explained above (albeit briefly), psoriatic arthritis is an inflammatory arthritis that occurs in patients with psoriasis. But wait – what’s psoriasis? As explained by the National Psoriasis Foundation, psoriasis is:

a chronic, systemic inflammatory, immune-mediated disease, meaning that it is typically a lifelong disease characterized by excessive inflammation in the body that negatively affects the skin, joints, and other organs in the body. Exactly what triggers the immune system to become overactive and attack the body is not entirely known, but it appears to be due in part to our genetics, the environment, and other variables such as obesity, medications, and infections.

So psoriatic arthritis occurs in patients, characterized by joint issues and skin lesions which often appear as red patches with silvery scales. In some cases, joint issues occur prior to skin issues, though not always. Symptoms, which can affect one or both sides of the body, include:

• Red skin with silver scales
• Swollen fingers and toes
• Tendon and joint pain, swelling, stiffness, and tenderness
• Fatigue and general malaise
• Morning stiffness
• Eye pain and redness (conjunctivitis, uveitis)
• Diarrhea OR constipation
• Abdominal pain and bloating
• Changes in the nail (discoloration, separation from nail bed)
• Reduced range of motion
• Organ damage and poor function

Back Pain

So now that we have a better idea of the symptoms associated with psoriatic arthritis, let’s talk back pain, specifically in the lower back. Oftentimes, back pain is associated with a more severe psoriatic arthritis diagnosis, causing issues with quality of life (QOL) and daily activities. Patients with this condition may experience different types of back pain, such as:

• Mechanical. In this form of back pain, patients have a physical injury to the lumbar area of the spine. Because it is caused by injury, mechanical back pain can occur when patients are of any age. However, mechanical back pain is often seen in older individuals and improves with relaxation and low energy.
• Inflammatory. Alternately, patients with inflammatory back pain experience pain which worsens with rest and at night, though it feels somewhat better through exercise and activity. This form is typically caused by joint inflammation (from psoriatic arthritis), lasts for over three months, and usually affects those under 40 years old.

Researchers discovered that HLA-B27 gene markers could identify patients with psoriatic arthritis that might impact the spine. Through research, HLA-B27 was shown to cause spinal joint inflammation, leading to inflammatory pain. As the spine repeatedly becomes inflamed, the bones weaken. In fact, patients may even experience some bone loss or degeneration.

To diagnose psoriatic arthritis and best assist patients with either mechanical or inflammatory pain, there are a few steps. First, patients may undergo a spinal X-ray to learn how the condition affects the spine. MRI and blood testing are also used. In some cases, doctors specifically seek out blood testing to ensure that patients have psoriatic arthritis and not rheumatoid arthritis (RA), which may sometimes present in a similar fashion.

Treatment and Moving Forward

One of the key parts of treating and managing psoriatic arthritis is ensuring that patients live a healthy lifestyle. This includes hydration and a good diet, healthy sleeping patterns, exercising (when possible), and developing promising coping mechanisms for dealing with stress.

Patients with psoriatic arthritis and back pain can also receive different types of treatment. Medications, like NSAID pain relievers or prescription therapies, can reduce pain and inflammation in the body. If you have psoriatic arthritis and are looking for help, you may also speak to your doctors, or even a physical therapist, about various stretches to improve joint stiffness and reduce pain. Doctors suggest that, for those with serious back pain, physical therapy, alongside an over-the-counter (OTC) therapy or prescription medication, is the best option for patients with inflammatory back pain. Rest and physical therapy are thought to be the best option for the other form.