Back Pain and Psoriatic Arthritis? Here’s What You Need to Know

Back pain is a common symptom among people living with psoriatic arthritis (PsA). Learn what causes PsA back pain, how doctors diagnose it, what it feels like, and treatment options.

PsA is a chronic autoimmune condition that can cause inflammation and joint pain. Many people with PsA also live with psoriasis, a skin condition that causes scaly, itchy plaques on your skin. Experts estimate that 30% of people with psoriasis develop PsA.

The exact cause of PsA is currently unknown, but several factors may increase the risk of having PsA. These include having a family history of psoriasis, psoriasis itself, or having overweight.

While PsA often links with joint pain in areas like your fingers, knees, ankles, or elbows, back pain is a common symptom.

Here’s what you need to know about PsA and back pain.

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Spondylitis and sacroiliitis

When PsA affects your spine and back, it’s called axial arthritis.

Experts generally estimate that between 7% and 30% of individuals with PsA experience axial arthritis. But a research review from 2020 reported that this number might be closer to 70%.

One form of axial arthritis is spondylitis, which involves inflammation in ligaments between your vertebrae. Spondylitis may lead to erosion between your vertebrae or atypical bone growth. These complications can cause vertebrae to merge, limiting range of motion.

Studies have shown that doctors generally diagnose spondylitis in people with PsA under 40 years old. It can be difficult to diagnose spondylitis caused by PsA because there are many other causes of back pain. It’s common for individuals with PsA to live with back symptoms for many years before receiving a proper diagnosis.

People with PsA may often experience sacroiliitis, which involves inflammation of the sacroiliac joints, between your spine and pelvis. Often this manifests as pain in your lower back.

What does PsA back pain feel like?

Back pain associated with PsA can vary greatly from person to person. Some people may experience mild symptoms that come and go, while others may have severe, persistent symptoms. People can feel PsA-related back pain in their lower back, upper back, or neck. Back stiffness caused by PsA may make it more difficult to move.

The symptoms can include joint pain, swelling, and stiffness. Some people may experience a dull ache or soreness in their backs, while others may feel a sharp, stabbing pain focused around their joints. The pain can be constant or intermittent.

Some people notice that the pain is worse in the morning or after sitting or standing for long periods of time. Back pain caused by PsA may improve with movement or a warm shower.

How is PsA back pain diagnosed?

It can be hard to determine the cause of back pain. Experts typically classify back pain into two categories: inflammatory and mechanical.

Inflammatory back pain, like PsA-related back pain, typically involves pain lasting more than 3 months. Inflammatory back pain is more common in people under 40 years old.

In general, an individual with inflammatory back pain won’t be able to pinpoint an exact injury or event that triggered the onset of their pain.

You can often improve symptoms of inflammatory back pain with exercise, but they can get worse with rest. Inflammatory back pain may be more severe at night or first thing in the morning.

Mechanical back pain is more common than inflammatory back pain. It can occur at any age, but it occurs more often in middle-aged and older adults. Mechanical causes of back pain include sprained or strained muscles and structural damage like herniated discs.

You can usually improve mechanical back pain symptoms with rest, but they can worsen with movement.

To determine the cause of your back pain, your doctor may ask about your medical history, perform a physical exam, and order imaging tests, like X-rays, CT scans, or MRIs.

If your doctor suspects that you have inflammatory back pain, they may order blood tests to check for markers of inflammation, which can be present in conditions like PsA.

If your doctor believes your back pain may result from PsA, they may ask if you’ve noticed other symptoms, like:

• joint pain and stiffness in other body parts
• skin plaques or rashes
• nail changes
• fatigue

Treatment

While there’s currently no cure for PsA, many treatment options can help manage symptoms and slow the disease progression. Treatment for PsA-related back pain includes:

• medication
• physical therapy
• nutritional changes
• better sleep

Medications that may treat PsA-related back pain include:

• nonsteroidal anti-inflammatory drugs
• disease-modifying antirheumatic drugs
• biologics
• corticosteroid injections

These medications can help reduce inflammation and lessen joint pain. Heat and cold therapy may also provide temporary relief.

Physical therapy and exercise can also benefit people experiencing back pain caused by PsA. Joint-friendly exercises, like swimming, cycling, and yoga, can help improve flexibility and reduce stiffness. Physical therapy can also help improve mobility and strength in the affected joints.

Lifestyle changes like eating a nutritious diet and getting better sleep may also help manage symptoms.

The bottom line

Back pain is a common symptom of PsA, but there’s a wide range of experiences of PsA-related back pain.

If you live with PsA and experience back pain, it’s also possible that your back pain doesn’t actually link with PsA at all. Talking with your doctor can help determine if PsA is causing your back pain or if you have a mechanical concern like a strained muscle or herniated disc.

While there’s currently no cure for PsA, many treatment options can help you manage PsA symptoms like back pain.

If your back pain isn’t improving or makes it difficult to do everyday tasks, talk with your doctor about finding a new treatment plan.

It can also be helpful to connect with others who have PsA. Support groups and online communities like Bezzy PsA can be valuable sources of information and emotional support.