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Q: My husband was recently told there is a connection between psoriasis and back pain. Could you please explain this?
A: The connection between psoriasis and back pain is surprising to many. But 5 to 10 percent of patients with psoriasis develop a condition called psoriatic arthritis.
In most patients, the psoriasis comes first. Then it's followed years later by the arthritis.
It's odd, but when the nails are involved with psoriasis, the chances of having psoriatic arthritis go up as high as 50 percent.
Psoriatic arthritis is one of the "spondyloarthropathies." This means the spine and joints in the arms and legs may be involved. Other conditions in this family of arthritis disorders include ankylosing spondylitis, colitis-associated arthritis and reactive arthritis.
In psoriatic arthritis, the joints affected most are the sacro-iliac (SI) joint, the last joints of the fingers or toes (nearest the nail), the knee and ankle.
When it affects the SI joint, it usually leads to chronic low back pain on one or both sides. This pain is usually worse in the morning, and gets better with exercise. Other more common causes of back pain, such as muscle strain or disc disease, often get worse with exercise. These problems tend to improve in a few weeks.
Treatment for psoriatic arthritis often includes:
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Regular exercise
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Anti-inflammatory medicines
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Pain medicines
- Physical therapy
Some people need cortisone injections or more powerful medicines that ease inflammation.
Of course, it's possible that your husband's back pain and psoriasis are not related. Both are common conditions. And he could simply be unlucky enough to have both.
The specific features of the back pain, mentioned above, should help sort out whether or not they are related. Sometimes, X-rays and blood tests are useful. But often, these results aren't definitive.
(Robert H. Shmerling, M.D. is a practicing physician in rheumatology at Beth Israel Deaconess Medical Center and an Associate Professor in Medicine at Harvard Medical School.)
