What Are The Presenting Features Of Psoriatic Spondylitis and How To Treat It?

About Psoriatic Spondylitis:

Psoriatic Spondylitis refers to a subset of psoriatic arthritis in which the pelvic joints and the spine gets affected. The affected individual will tend to have pain and stiffness around the pelvic region up to the neck. As is the case with other forms of arthritis, Psoriatic Spondylitis also causes severe inflammation of the joints, especially the neck and low back. As the condition progresses, it becomes extremely difficult for the individual to attempt any movement of the spine such as pivoting, turning the neck, or bending or twisting.[2]

How common is Psoriatic Spondylitis is something which is not mentioned in research data but some researchers believe that around 1% of general population are affected by this condition. This makes Psoriatic Spondylitis quite uncommon. The symptoms of this condition are generally mild at their onset and worsen gradually as the condition progresses. There will be significant damage observed on radiographs in the advanced form of Psoriatic Spondylitis. The quality of life of the patient gets severely compromised due to Psoriatic Spondylitis.[1]

The lack of proper data on this condition is believed to be partially due to the condition not being properly diagnosed by clinicians. The relation between psoriasis and arthritis has been studied widely. These studies show that around 30% of people with psoriasis end up having Psoriatic Spondylitis. Similarly there were several cases of people with Psoriatic Spondylitis attending psoriatic clinic.[1]

This shows a close connection between psoriasis and Psoriatic Spondylitis. This article gives an overview of some of the presenting features of Psoriatic Spondylitis and different management approaches that can be employed to treat the condition.[1]

What Are The Presenting Features Of Psoriatic Spondylitis?

The presenting features of Psoriatic Spondylitis are quite similar to the symptoms of other forms of arthritis except that it affects the spine and sacroiliac joints. The symptoms are mild at the onset of the condition but tend to worsen as the disease progresses. An individual with Psoriatic Spondylitis will experience back pain with lumbar spine stiffness which will make it tough for the individual to bend, lift, or twist the body.[2]

The neck area also becomes extremely stiff and painful and the individual will feel pain when moving the neck to look at the sides. Stretching the back and neck will often tend to improve the symptoms. Sleeping will make the symptoms worse. The individual will always feel fatigued and lethargic and will have no interest in doing any type of work. The pain will gradually become debilitating and impact the quality of life of the individual.[2]

If the condition is not treated on time then the inflammation can inflict significant damage to the spine and the SI joints. During the initial stages, the symptoms of Psoriatic Spondylitis wax and wane and gradually become worse. During the phases when the symptoms are severe it is termed as a flare up of Psoriatic Spondylitis. However, the location of the pain and inflammation may change with every flare.[2]

Treatment of Psoriatic Spondylitis

Coming to the treatments of Psoriatic Spondylitis, it is aimed mainly at controlling the inflammation and prevent further damage to the SI joints and the spine. Control over inflammation also reduces the risk of cardiovascular illnesses. Once the treatment starts to kick in and there is substantial control of the inflammation, pain, and stiffness, the patient is said to be in remission.[2]

Biologic Therapy: This is aimed at reducing the inflammation and controlling the symptoms. It also controls the number of flares that an individual has of Psoriatic Spondylitis and delays the progression of the disease. It works by targeting the immune system to control the symptoms.[2]

Treatment guidelines for Psoriatic Spondylitis published in 2018 has mentioned the use of biologic therapy for people with newly diagnosed Psoriatic Spondylitis. This can be done either through infusion or shots.[2]

However, the side effect profile of the medications used in biologic therapy along with increased likelihood of infections does not make everybody with Psoriatic Spondylitis a candidate for this form of treatment. Before starting the treatment, the physician will discuss in detail the potential risks versus benefits of this treatment in detail before starting it.[2]

Disease-Modifying Antirheumatic Drugs: Also known as DMARDs, these medications decrease inflammation and also suppresses the immune system. Methotrexate and azathioprine are most preferred medication that suppresses the immune system. Sulfasalazine controls the inflammation. Combination of these drugs prevents damage to the joints. These medications can be given in the form of injections or oral pills.[2]

Antiinflammatory Medications: NSAIDs are often at times used for treating mild forms of Psoriatic Spondylitis. They help in relieving pain, control inflammation, and also reduce joint stiffness caused by Psoriatic Spondylitis. This however should not be a long term option since chronic use of NSAIDs can cause other health problems.[2]

Corticosteroids: These are used for quick relief of the symptoms of Psoriatic Spondylitis. They are the stronger form of antiinflammatory medications. They are generally injected directly into the affected joint. Prednisone is the most common corticosteroid used for treating Psoriatic Spondylitis.[2]

However, chronic use of this medication may cause significant side effects like hypertension or osteoporosis. Individual using corticosteroids as a treatment option often tends to have a flare of Psoriatic Spondylitis once the medication is stopped.[2]

Physical Therapy: This is yet another option for treating Psoriatic Spondylitis. Physical therapy allows the inflammation to calm down and makes the joint supple which helps preventing joint stiffness. If the muscles are strong then there will be less stress put on the joints preventing damage to them due to Psoriatic Spondylitis.[2]

The physical therapist will formulate a detailed exercise regimen specific to Psoriatic Spondylitis. A visit to an occupational therapist is also helpful as they can suggest ways to reduce pain and inflammation while the affected individual is at work.[2]

Apart from medications, there are also certain home remedies that can be quite effective in treating Psoriatic Spondylitis. It should be noted that these remedies should be used along with the medications that the physician has prescribed to treat Psoriatic Spondylitis. These remedies include:[2]

Exercise: Exercising regularly helps the body to stay fit and keep the muscles and joints strong and supple. Thus it is no surprise that exercising also can help with the symptoms of Psoriatic Spondylitis. Additionally exercising results in the production of endorphins which makes an individual feel good.[2]

For people with Psoriatic Spondylitis, it is recommended that they get involved with low impact exercises like swimming or cycling. Yoga is also quite effective in controlling the symptoms of Psoriatic Spondylitis.[2]

Sleeping: A restful sleep is always good for health. Research suggests that excessive fatigue makes the symptoms of Psoriatic Spondylitis worse. Thus following a regular sleep schedule is essential to prevent worsening of the condition.[2]

Identify Triggers: It is essential to have knowledge of what foods or activities worsen the symptoms of Psoriatic Spondylitis. Avoiding these triggers are essential to prevent flare of symptoms. Thus it is recommended to maintain a diary noting down the various triggers for a flare of symptoms of Psoriatic Spondylitis. [2]

Massage Therapy: This is another effective way to treat the symptoms of Psoriatic Spondylitis. Getting massage on the affected joints relieves tension on the joints and prevents them from getting stiff.[2]

Avoid Alcohol/Smoking: It is also essential for people with Psoriatic Spondylitis to avoid smoking and alcohol use as they can help in increasing inflammation and may even cause complications.[2]

In conclusion, Psoriatic Spondylitis is a rare form of psoriatic arthritis which affects the sacroiliac joints and the spine. An individual with Psoriatic Spondylitis will find it difficult to move the spine and any attempts at movement will cause intense pain. This condition significantly affects the quality of life of the affected individual. However, there are numerous treatments available now it has become quite easy to manage the condition.[2]

The treatments also calm down the inflammation and prevent further damage to the joints. As of now, there is no definitive cure for Psoriatic Spondylitis but the symptoms can definitely be controlled with medications and therapy. A detailed plan should be formulated for controlling the symptoms.[2]

Medications, physical therapy, DMARDs, and biologic therapy are believed to be most effective in the treatment of Psoriatic Spondylitis. Additionally, maintaining good sleep hygiene, exercising, and a balanced diet also helps in preventing damage to the joints and worsening Psoriatic Spondylitis.[2]