When Back Pain May Mean Arthritis
Many forms of arthritis and related conditions can cause back pain, stiffness and swelling.
About 80% of back pain is acute and usually lasts one to seven days. Otherwise, its considered chronic and may be caused by arthritis. The lower back is the most common site of arthritis back pain. Several types of arthritis are part of a group of conditions called spondylarthropathies . Spondylarthropathies can affect adults and children.
If you are experiencing pain, swelling and stiffness in the back, you may have one of the following types of arthritis or related conditions.
Axial Spondyloarthritis
Axial spondyloarthritis is a chronic inflammatory disease that primarily affects hip joints and the joint that connects the bone at the bottom of the spine to the pelvis .
There are two types of axSpA: Radiographic axSpA includes damage to the sacroiliac joints and spine that can be seen on X-rays, and nonradiographic axSpA does not include damage you can see on X-rays but it may show up on magnetic resonance images .
Osteoarthritis
Psoriatic Arthritis
Psoriatic arthritis is a form of arthritis that affects joints and usually the skin . For about 20 percent of people with PsA, the disease involves the spine . In some cases, bony overgrowth can cause two or more vertebrae to grow together , causing stiffness.
Reactive Arthritis
Enteropathic Arthritis
Spinal Stenosis
Getting a Proper Diagnosis
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Your Energy Level Is Like A Bank Account
Psoriatic arthritis can cause extreme fatigue. For every task you complete, or plan to complete, you drain your daily energy bank. Putting on mascara or talking to a neighbor on the street costs you energy. And sometimes, even if its the first thing you do after waking up, a shower may be all it takes to put you right back in bed.
Its important to rest when you need to and not push yourself too hard, especially on days when your symptoms are particularly severe, says Joseph Markenson, MD, a rheumatologist at Hospital for Special Surgery in New York City. Its also important for the loved ones of those who have psoriatic arthritis to understand how draining the condition can be for example, people with psoriatic arthritis may have to cancel plans frequently or head home early.
How Psoriatic Arthritis In The Spine Is Treated
Another reason its important to talk to your doctor if you think you might have spondylitis is that early treatment reduces the risk of progressive loss of spinal mobility and function. A number of treatments can help reduce pain and other symptoms associated with spondylitis in people with psoriatic arthritis, including:
- Tumor necrosis factor inhibitors
- Biologic drugs, including interleukin -12, IL-17, or IL-23 inhibitors
- Physical therapy
Youll likely be on at least one of these medications long term, because odds are good that it will work. Most patients improve, and we see fairly high rates of remission, says Davis.
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What Is An Autoimmune Disease
Autoimmune disease happens when the bodys natural defense system cant tell the difference between your own cells and foreign cells, causing the body to mistakenly attack normal cells. There are more than 80 types of autoimmune diseases that affect a wide range of body parts.
According to the classification criteria of the Assessment of SpondyloArthritis international Society , inflammatory back pain typically lasts for three months or more with an insidious or unknown onset, begins in patients at an age younger than 40, improves with exercise but gets worse with rest, and causes increased pain at night.
Mechanical back pain, however, can have an onset at any age, although it is more common in middle-aged and older individuals, can be acute from a specific event that causes an injury, and often feels worse with movement but improves with rest. These symptoms can result from injury or damage to the lower back muscles, tendons, ligaments, discs, joints, or vertebrae.
Psoriatic Arthritis Risk Factors
- Psoriasis. Up to 30% of people with psoriasis get psoriatic arthritis. It affects men and women equally.
- Age. You can get PsA at any age, but it usually affects people between 30 and 50.
- Family history. As many as 40% of people with psoriatic arthritis have a family history of skin or joint disease.
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What Are The Symptoms Of As
Signs and symptoms of AS will commonly develop along the spine, but may progress over the course of the disease. People with AS often experience spinal stiffness and loss of spinal mobility due to inflammation.
To better understand inflammation and AS symptoms, and the role the immune system plays in both, weve enlisted Dr. Elizabeth Perkins, a practicing rheumatologist, for help.
It really starts with how we look at the immune system. You basically have different cytokines circulating throughout the body. But in autoimmune diseases, those cytokines can be out of balance.
In our healthy state, that balance is nice and orchestratedthink of it like musical instruments. Everything sounds just right. But in states like AS, some of those cytokines get turned on and overproduce. They get very noisy. And that overproduction of cytokines causes inflammation that can be felt as lower back pain and stiffness.
Dr. Elizabeth Perkins, a Practicing Rheumatologist
As Can The Words Youre Too Young To Have Arthritis
When you say the word arthritis, every older person you meet has it, too, Dishner says. While well-meaning people may sympathize by comparing their own ailment with yours, psoriatic arthritis is a much different form of arthritis and does not develop because of aging. It can occur at any age but typically begins to cause symptoms among those between 30 and 50 years old, according to the NPF.
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Osteoarthritis Of The Spine
The bones in your spine are separated by spongy discs, which act as shock absorbers. With age, these discs can wear or shrink, which narrows the space between the spinal joints, or facet joints. The facet joints are a series of small joints in the lower back that contain the same type of cartilage that is found in your knees, explains Louw. Disc changes can lead to more strain on the joints, which can cause the cartilage to wear down and the facet joints in the vertebrae to rub against one another, leading to the pain and stiffness of OA. It is not uncommon for these joints to refer pain into the buttocks, especially with prolonged standing or even walking, says Louw.
Spinal Arthritis Causes And Risk Factors
The causes of arthritis in the back or neck vary depending on the type of arthritis you have. Besides normal wear and tear and autoimmune triggers, in many cases the exact cause remains unknown. Genetic components have been identified in connection with some forms of spinal arthritis, meaning that it may be hereditary.
Other spinal arthritis risk factors include:
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Excess weight/obesity
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Presence of certain conditions such as diabetes, gout, psoriasis, tuberculosis, irritable bowel syndrome and Lyme disease
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Appropriate Screening For Back Pain In Psa
Back pain is one of the most common reasons for physician visits globally and the most costly in terms of healthcare provider visits , leading to significant direct medical costs and indirect societal costs arising from absenteeism, presenteeism, disability, and workers compensation claims . Because back pain has many different causes that can present with similar symptoms, it can be difficult to identify its fundamental pathological features during musculoskeletal evaluation . Back pain is very common in the general population approximately 80% of people experience it in some form at least once in their lifetimes . Most chronic back pain episodes are reported to be mechanical in nature. Nonmechanical causes may include those being of rheumatologic, vascular, gastrointestinal, renal, infectious, or oncologic origin .
Back pain can impair productivity, which influences long-term profitability . In a 4-year review of presenteeism data among employees of a large US healthcare system, chronic back pain ranked among the highest for minutes of daily productivity loss and annual cost per person . Low back pain with or without lower extremity pain is one of the most common reasons for physician visits, and treatment costs remain a significant burden on healthcare resources . In a recent US study, the total cost of care over 12 months after diagnosis was $1.8 billion among patients with low back pain with or without lower extremity pain and not undergoing surgery .
Medications For Pain Relief
If your muscle pain is negatively affecting your quality of life or causing you significant discomfort, medications may help relieve it. Over-the-counter non-steroidal anti-inflammatory drugs like ibuprofen or naproxen could help. However, if you are already taking NSAIDs for psoriatic arthritis, you should consult your rheumatologist before taking more.
You may also ask your doctor about muscle relaxants. Although muscle relaxants have not been shown to help with psoriatic arthritis itself, they could help reduce your muscle pain especially if it is extreme.
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Changing Your Diet Wont Cure Psoriatic Arthritis
There is no known cure for psoriatic arthritis, and making dietary changes like going paleo or gluten free isn’t a remedy. The good news, however, is that a healthy diet with plenty of anti-inflammatory fruits and vegetables that’s low in fats and sugars can help keep psoriatic arthritis symptoms under control. Also try to steer clear of dairy and caffeine, which may aggravate psoriatic arthritis symptoms, says Dr. Markenson.
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How Painful Can Psa Get
In a 2018 review of research, scientists found that people with PsA report high levels of pain and functional disability. This affects their ability to work and do day-to-day activities. It may also have an impact on their sleep, levels of fatigue, and overall quality of life.
When scientists asked people from 13 countries to rank the impacts of PsA, they ranked pain as the most impactful. PsA may cause pain in the joints, the skin, and other body parts.
Pain and other symptoms tend to worsen during a flare, which is when the condition is active. Flares may last for a few days or months.
In PsA, the immune system attacks healthy tissues. This causes inflammation and tissue damage. Some common symptoms include:
- joint swelling, stiffness, tenderness, and pain
- painful swelling of entire fingers or toes
- back pain and limitation of motion
- pain in the heel or sole of the foot
- fatigue
Chronic inflammation can eventually cause permanent joint damage and disability.
Many people with PsA also have symptoms of psoriasis, including itchy and painful skin lesions.
People with PsA are also at increased risk of inflammation in other body parts, including the eyes and the digestive system. This can add to their discomfort.
What Causes Psoriatic Arthritis
The cause of psoriatic arthritis is unknown. Researchers suspect that it develops from a combination of genetic and environmental factors. They also think that immune system problems, infection, obesity, and physical trauma play a role in determining who will develop the disease. Psoriasis itself is neither infectious nor contagious.
Recent research has shown that people with psoriatic arthritis have an increased level of tumor necrosis factor in their joints and affected skin areas. These increased levels can overwhelm the immune system, making it unable to control the inflammation associated with psoriatic arthritis.
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How To Tell If Back Pain Is Related To Psoriatic Arthritis Or Something Else
If your back is bothering you, its important to check in with your doctor to get to the root cause.
Ankylosing spondylitis is one condition thats often confused with psoriatic arthritis. Both psoriatic arthritis and ankylosing spondylitis are in the family of spondyloarthritis and are highly related, explains Davis. Ankylosing spondylitis is another type of inflammatory arthritis. It causes the vertebrae in the spine to fuse, resulting in back pain.
People with ankylosing spondylitis are more likely to lose spinal mobility than those with axial-psoriatic arthritis, although the latter may lose range of motion. Most people with axial-psoriatic arthritis also have pain in their peripheral joints hands, feet, ankles but its possible to experience back pain only.
Ultimately, imaging of your back will help your doctor determine whether you have axial-psoriatic arthritis or ankylosing spondylitis. Although there is overlap, there are some subtle differences in the appearances of X-ray changes in both the sacroiliac joints and the spine, explains Davis.
That said, its easy to mistake symptoms of one condition for the other. What appears to be mechanical pain could be inflammatory pain, and what appears to be inflammatory pain could be mechanical pain, says Bhatt.
People who have psoriatic arthritis may also have back pain linked to a number of other causes, says Davis, including:
Past Research And Achievements In This Area
In 2015, research led by our centre for genetics and genomics at the University of Manchester identified genetic variants associated with psoriatic arthritis, but not with psoriasis or rheumatoid arthritis. This helped to establish psoriatic arthritis as a condition in its own right. The findings could lead to the development of drugs specifically for psoriatic arthritis.
Later in the same year, our TICOPA trial looked at the benefits of early aggressive drug treatment for people with psoriatic arthritis followed by an increase in drug dosage if initial treatment isnt working. The trial found that patients treated this way, required fewer hospital- and community-based services than patients receiving the standard care.
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Three Signs Point To A Diagnosis Of Psoriatic Arthritis
Doug Brunk
LOS ANGELES, California If a patient with psoriasis presents with dactylitis, inflammatory back pain, and/or tendon inflammation, think psoriatic arthritis until proven otherwise.
Amanda Mixon speaks at the 19th Annual Fall Dermatology Conference of the Society of Dermatology Physician Assistants .
At the annual fall meeting of the Society of Dermatology Physician Assistants, Amanda Mixon, PA-C, said that psoriatic arthritis occurs in 20% to 30% of individuals with psoriasis, “but my guess is that number is higher than that.” Mixon practices at the Colorado Center for Arthritis and Osteoporosis, Longmont, Colorado. Psoriasis usually precedes PsA by 8 to 10 years, and PsA affects both genders equally, usually in the fourth decade of life. Genetic and environmental factors play a role.
On clinical presentation, 95% of patients with PsA have peripheral joint disease in the form of synovitis, tenosynovitis, dactylitis, and/or enthesitis, often asymmetric. “They can have little psoriasis and terrible arthritis, or vice versa,” Mixon said. “They don’t automatically correlate with each other. The one thing that does, though, is nail psoriasis. That will correlate with dactylitis, which is basically an inflamed sausage-like finger or toe, which happens for no apparent reason. That is a classic finding of psoriatic arthritis, a slam dunk. It’s important to refer those patients to a rheumatologist.”
Work And Psoriatic Arthritis
Having psoriatic arthritis may make some aspects of working life more challenging. But, if youre on the right treatment, its certainly possible to continue working.
Help and support is available, and you have rights and options.
The Government scheme Access to Work is a grant that can pay for equipment to help you with activities such as answering the phone, going to meetings, and getting to and from work.
The 2010 Equality Act, and the Disability Discrimination Act in Northern Ireland makes it unlawful for employers to treat anyone with a disability less favourably than anyone else. Psoriatic arthritis can be classed as a disability if its making every-day tasks difficult.
Your employer may need to make adjustments to your working environment, so you can do your job comfortably and safely.
You might be able to change some aspects of your job or working arrangements, or train for a different role.
In order to get the support youre entitled to, youll need to tell your employer about your condition. Your manager or HR department might be a good place to start.
Other available support might include:
- your workplace occupational health department, if there is one
- an occupational therapist. You could be referred to one by your GP or you could see one privately
- disability employment advisors, or other staff, at your local JobCentre Plus
- a Citizens Advice bureau particularly if you feel youre not getting the support youre entitled to.
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Types Of Arthritis That Affect The Back
If you have arthritis in your back, its important to understand the type of arthritis that might be causing it. Different types of arthritis have specific medications and treatments. Here are some of the more common types of arthritis that affect the back.
It is common for people with back pain to have more than one cause, which could include arthritis as well as other causes .
What Are The Treatment Options For Psoriatic Arthritis
The aim of treatment for psoriatic arthritis is to control the disease and relieve symptoms. Treatment may include any combination of the following:
- Splinting.
- Surgery.
Choice of medications depends on disease severity, number of joints involved, and associated skin symptoms. During the early stages of the disease, mild inflammation may respond to nonsteroidal anti-inflammatory drugs . Cortisone injections may be used to treat ongoing inflammation in a single joint. Oral steroids, if used to treat a psoriatic arthritis flare, can temporarily worsen psoriasis. Long-term use of oral steroids should be avoided when possible due to the negative effects on the body over time.
DMARDs are used when NSAIDs fail to work and for patients with persistent and/or erosive disease. DMARDs that are effective in treating psoriatic arthritis include: methotrexate, sulfasalazine, and cyclosporine.
Biologic agents are an important consideration when disease control is not being achieved with NSAIDS or DMARDs. Biologics have been utilized for the treatment of psoriatic arthritis since 2005 and are highly effective at slowing and preventing progression of joint damage. Your healthcare provider will complete additional laboratory tests and review safety considerations before initiating a medication regimen. Gaining good control of psoriatic arthritis and psoriasis is important to avoid increased systemic risks, particularly heart disease.
Exercise
Heat and cold therapy
Splinting
Surgery
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