Psoriatic Spondylitis | Causes | Symptoms | Treatment | Diagnosis

What is Psoriatic Spondylitis?

Psoriatic Spondylitis is a variant of psoriatic arthritis characterized by inflammation of the spine. This condition makes movement of the neck, back, pelvis, and sacral joints difficult. Psoriatic Spondylitis also causes pain in the upper and lower extremities. Studies have shown that around 40% of people with psoriatic arthritis end up having Psoriatic Spondylitis. This condition is also at times referred to by the name of axial disease. Psoriatic Spondylitis in majority of the cases affects only one side of the body.[1]

This condition causes severe back pain and the extent of the inflammation can be easily visualized on radiographic images like an MRI scan. Psoriatic Spondylitis is quite similar to ankylosing spondylitis which affects the spine and the large joints. They both are autoimmune disorders and are caused due to mutation of the HLA-B27 gene. The mutation of this gene makes the affected individual vulnerable to various autoimmune conditions.[1]

What Causes Psoriatic Spondylitis?

The primary cause of Psoriatic Spondylitis is still not clearly understood by the physicians. Some theories suggest that certain infections like a strep throat trigger an autoimmune response from the body which results in Psoriatic Spondylitis. It has also been seen that an individual with a family history of this condition is at most risk for developing Psoriatic Spondylitis. The primary risk factor for Psoriatic Spondylitis is the presence of the HLA-B27 gene mutation which is also a cause for a variety of other autoimmune disorders.[2]

The presence of this gene can be easily checked by conducting a blood test. However, it should be mentioned that just having this gene does not in any way suggest that the individual will ultimately develop Psoriatic Spondylitis. It just increases the risk of this disease. It has also been seen that people with a known diagnosis of psoriasis tend to get Psoriatic Spondylitis but it does not happen every time. There is no age prevalence in the development of Psoriatic Spondylitis; however, it is generally seen in people above the age of 30.[2]

What are the Symptoms of Psoriatic Spondylitis?

The symptoms of Psoriatic Spondylitis are quite similar to that of other forms of arthritis with spine involvement. These conditions include ankylosing spondylitis and reactive arthritis. An individual with Psoriatic Spondylitis will experience severe back pain along with restricted range of motion of the back and stiffness. Any attempts at moving and pivoting will cause severe pain in the low back. The stiffness of the back will worsen by inactivity such as when sleeping and getting up first thing in the morning. The individual will also have problems bending to lift something up. The individual will also be persistently fatigued with even minimal activity.[2]

The pain may reach to such a level that doing activities of daily living might become a challenge for the individual. If the condition is left untreated then severe damage can be incurred to the spine and the pelvis. The symptoms of Psoriatic Spondylitis are waxing and waning in nature.[2]

When the symptoms are at their peak then it is referred to as a flare up of Psoriatic Spondylitis and while there are minimal to no symptoms then it is referred to as period of remission. The location of the pain and inflammation keeps on changing.[2]

How is Psoriatic Spondylitis Diagnosed?

The diagnosis of Psoriatic Spondylitis begins with taking a history of the patient. He or she may also be asked to fill out a questionnaire pertaining to the symptoms that are seen with Psoriatic Spondylitis. This will give the physician a brief idea of whether the symptoms truly are of Psoriatic Spondylitis. If this condition is suspected then the next step towards diagnosis is to conduct a variety of tests.[2]

This will include tests to rule out other forms of arthritis that may cause the same symptoms. Other causes of back pain like disc disease or lumbar spine problem will also be ruled out. The physician will also look for any signs of psoriasis in the body which can be easily seen by the presence of scaly skin or pitting nails. Radiographs of the spine will also be obtained in the form of x-ray, CT or MRI scans.[2]

A blood test will also be conducted to look for the presence of HLA-B27 gene. Additionally, people with Psoriatic Spondylitis will have a low RBC count. The results of these tests will confirm the diagnosis of Psoriatic Spondylitis.[2]

How is Psoriatic Spondylitis Treated?

The pain and other symptoms that are caused by Psoriatic Spondylitis can be quite challenging to treat but there are quite a few options available for symptoms relief. The treatment is aimed at calming down the symptoms and preventing any further damage to the joints and spine. It is also aimed at increasing the periods of remission and reducing flares as much as possible. For this, the following options are effective.[2]

Biologic Therapy: They can decrease the severity of the symptoms and reduce the flares to a significant degree. This therapy is also quite effective in delaying the progress of Psoriatic Spondylitis by targeting the immune system. The guidelines for treatment of Psoriatic Spondylitis have clearly mentioned the use of biologic therapy especially in people who have recently been diagnosed with Psoriatic Spondylitis.[2]

The medication in biologic therapy is either given by an injection or infusion. However, the medications used in biologic therapy have significant side effect profile and is not recommended for everyone, especially in people with any other indwelling medical condition. It should be left to the discretion of the physician as to whether or not a patient with Psoriatic Spondylitis is a candidate for biologic therapy or not.[2]

Small Molecule Medications: This form of treatment is given to those patients who are not deemed to be a candidate for biologic therapy. These medications work by preventing the immune system from attacking the joints and skin thus slowing down the progress of Psoriatic Spondylitis. Some of the medications that come under small molecule medication list are Otelza and Xeljanz.[2]

DMARDs: These medications help in decreasing inflammation and also suppress the immune system of the body. Some of the medications that come under DMARDs include methotrexate, azathioprine, and cyclosporine, and sulfasalazine. These medications are extremely effective in slowing down the progress of Psoriatic Spondylitis and prevent any further damage to the joints of the spine and other joints. These medications can be taken orally or in the form of an injection.[2]

NSAIDs: These medications are given to reduce inflammation and reduce pain caused by Psoriatic Spondylitis. It also helps in decreasing stiffness. Ibuprofen and Tylenol or aspirin are some of the most preferred medications under the category of NSAIDs used for treating Psoriatic Spondylitis. It should be noted here, however, that NSAIDs cannot be used chronically as they can cause significant side effects. The use of these medications should be discussed with the physician first before starting it.[2]

Corticosteroids: These medications are given for people who do not find NSAIDs effective. This is given both orally as well as an injection directly into the joint that is causing pain. These medications provide short term relief from pain and inflammation. If corticosteroids are used frequently then it may cause side effects like weight gain, osteoporosis, and hypertension. Additionally, the psoriasis can also flare up significantly when an individual is on steroids.[2]

Physical Therapy: This forms a vital part of the treatment of Psoriatic Spondylitis. Exercises are quite effective in calming down the inflammation and provide pain relief. They also make the muscles strong and put less strain on the joints. A consultation with a physical therapist is essential so a detailed exercise regimen can be formulated that will best suit the patient’s needs and provide relief from the symptoms of Psoriatic Spondylitis.[2]

Other than the medical treatments mentioned above, an individual with Psoriatic Spondylitis can also try certain things at home which will help in relieving the symptoms of Psoriatic Spondylitis. These methods can be followed along with the medical treatments that have been advised by the physician. These methods include[2]

Physical Activity: Staying active is essential for the joints of the body to remain flexible. It also helps an individual maintain an ideal weight as excess weight puts stress on the joint and exacerbates the symptoms. Additionally, exercise produces endorphins which give the individual a sense of well-being. For individuals with Psoriatic Spondylitis it is best to do low impact exercises like swimming and cycling.[2]

Regular Sleep: This is also quite essential for people with Psoriatic Spondylitis as irregular sleep patterns leads to fatigue which in turn makes the symptoms worse. Thus it is important for people with Psoriatic Spondylitis to have a regular sleep schedule made and ensuring to stick to it.[2]

Identify Triggers: Sometimes, the immune system of the body can act up with certain triggers which can be in the form of a food product, dust, smoke, or other factors. This can worsen the symptoms of Psoriatic Spondylitis. Thus it is important to have knowledge of what events or foods make the symptoms worse and avoiding them as much as possible.[2]

Diet: It is important for people with Psoriatic Spondylitis to eat a diet which reduces inflammation. Additionally, nutritious foods also help an individual stay active and lessen the fatigue which relieves the symptoms of Psoriatic Spondylitis.[2]

Alcohol Abstinence: It is extremely essential for people who are undergoing treatment for Psoriatic Spondylitis. This is because any form of alcohol may interfere with the working of medications and may also result in unwarranted side effects and make the symptoms worse.[2]

Nicotine Abstinence: Just like alcohol, smoking also can make the symptoms of Psoriatic Spondylitis worse and thus should be completely avoided till the symptoms completely resolve. For tis, the individual may join a quitting smoking program or take the help of professionals for the same.[2]

Stress Management: Stress is an important factor which can worsen the symptoms of Psoriatic Spondylitis. Thus it is essential for managing stress through healthful means by way of yoga or meditation or getting involved with hobbies.[2]

Hot/Cold Application: This form of treatment is also quite effective in calming down inflammation and providing pain relief from Psoriatic Spondylitis. The individual can use heat packs alternating with ice application for 15-20 minutes two to three times a day for pain relief.[2]

It should be noted that both heat and ice should not be applied simultaneously since it can cause blisters to form. Doing this for a few weeks consistently can help in getting rid of the symptoms caused by Psoriatic Spondylitis.[2]

In conclusion, Psoriatic Spondylitis is an autoimmune disorder characterized by inflammation of the spine and pelvis causing pain and restricted motion. The pain can be so bad that it may interfere with activities of daily living. People often find the symptoms of Psoriatic Spondylitis quite difficult to cope up with. However, with the treatments and home remedies mentioned above all of the symptoms can be effectively controlled.[1, 2]

If the individual follows the recommendations of the physician diligently, then there will be more periods of remission with no symptoms and less flare ups of the symptoms of Psoriatic Spondylitis. As of now, there is no cure for Psoriatic Spondylitis and treatments are aimed at controlling the symptoms. Thus it is essential for people with this condition to follow the advice of their physicians so as to lead a normal life even with Psoriatic Spondylitis.[1, 2]

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