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Psoriatic Spondylitis: Symptoms, Causes, and Diagnosis

Posted on June 04, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Kristopher Bunting, M.D.

Psoriatic spondylitis, also called psoriatic arthritis (PsA), is a type of spondyloarthritis. This group of autoimmune diseases causes inflammatory arthritis and other symptoms throughout the body. Here, we will discuss the symptoms and causes of psoriatic spondylitis, as well as how it is diagnosed and treated.

What Is Psoriatic Spondylitis?

Different types of spondylitis can affect different parts of the body. Psoriatic spondylitis can affect any joint, causing inflammation, pain, and progressive tissue damage. PsA is related to skin psoriasis and is caused by the same type of autoimmune response. It occurs when the body’s immune system mistakenly attacks healthy cells and tissues, leading to damage and inflammation.

In addition to affecting joints, especially of the spine, PsA can cause symptoms in the:

  • Eyes
  • Fingers and toes
  • Fingernails and toenails
  • Tendons
  • Ligaments

Learn more about spondylitis.

Symptoms of Psoriatic Spondylitis

The principal symptom of all types of spondyloarthritis is joint pain — usually involving the spine. According to the Spondylitis Association of America, symptoms of PsA can include the following:

  • Joint pain, stiffness, and swelling
  • Back pain and stiffness, including in the sacroiliac joints (where the spine attaches to the pelvis)
  • Loss of range of motion in affected joints
  • Pain where tendons and ligaments attach to bone (enthesitis)
  • Swelling of fingers or toes (dactylitis)
  • Skin psoriasis
  • Pitting and discoloration of the fingernails and toenails
  • Fatigue
  • Eye inflammation, including iritis and conjunctivitis

Psoriasis of the skin is not always a symptom, but changes to the nails are almost always present. Advanced cases can also develop fusion of bones in the spine (ankylosis).

Read more about symptoms of spondylitis.

What MySpondylitisTeam Members Say About Psoriatic Spondylitis

Some MySpondylitisTeam members have reported psoriasis as one of their spondylitis symptoms:

  • “I have psoriasis on one leg and my feet. It’s terrible, I’ve had just about every treatment and still haven't gotten any relief from the pain and itching.”
  • “I have PsA and spondylitis. Before doctors really knew much about it, I was dealing with the effects of it along with the embarrassing patchy skin of psoriasis.”

Other members have shared that they have multiple related diagnoses:

  • “I have degenerating disks, psoriasis, and psoriatic arthritis.”
  • “I had all the signs of irritable bowel syndrome and iritis along with a fused spine and psoriasis.“

MySpondylitisTeam members have shared how their psoriasis symptoms have affected them:

  • “I am having some trouble sleeping tonight due to psoriasis and the itching. “
  • “I'm glad the psoriasis is on the down low. Flare-ups are always a pain in the rump.”

MySpondylitisTeam members have also talked about how changes in diet have improved their psoriasis symptoms:

  • “I try to stay gluten-free. It helped clear my psoriasis on my skin but did nothing for the physical chronic pain.”
  • “I cut out wheat and corn products, started walking and swimming, and I feel great. I had psoriasis so bad under my armpits for a year and within a week of cutting all these from my diet it cleared up 100 percent.”

Another member said that their psoriasis worsened by eating certain foods:

  • “I've had flares the last few days. I bought some beef salami and after eating it my psoriasis flared up.”

Members have reported that stress plays a large role in their psoriasis flare-ups:

  • “I’m having a severe psoriasis flare now from the heavy loads of stress.”
  • “I want to share some good news for a change. I believe my plaque psoriasis is going into remission. I believe this is happening because my stress levels have decreased.“
  • “It's amazing, a lot of my stress has been resolved and my plaque psoriasis has improved greatly. It almost seems to be going back into remission.”

Causes of Psoriatic Spondylitis

Like other types of spondyloarthritis, the cause of psoriatic spondylitis is not entirely understood. Psoriasis and psoriatic spondylitis are presentations of the same autoimmune disease. Heredity is a risk factor for PsA, specifically having the HLA-B27 gene or having a family member with psoriasis. Psoriatic spondylitis may also develop after certain infections, including Streptococcal pharyngitis (strep throat), trigger the immune system to mount a faulty immune response.

Find out more about risk factors for spondylitis.

Diagnosis of Psoriatic Spondylitis

There are several methods for diagnosing psoriatic spondylitis, including:

  • A thorough medical history examination (including determining if there is a family history of psoriasis and psoriatic arthritis)
  • A physical exam
  • Imaging of the affected joints using X-rays, CT, and MRI
  • Blood tests for signs of inflammation, including C-reactive protein and erythrocyte sedimentation rate tests
  • A blood test for the HLA-B27 gene

Diagnosing psoriatic spondylitis is easier when psoriasis, dactylitis, or fingernail and toenail symptoms are present. Diagnosis may require ruling out other diseases, such as gout, and other forms of arthritis, including rheumatoid arthritis and osteoarthritis.

Read more about diagnosing spondylitis.

The Next Step: Treatment

Treating psoriatic spondylitis requires a whole-body approach. Maintaining and restoring function requires more than just medications that treat the symptoms and underlying causes of spondylitis. Key treatments used for all types of spondyloarthritis may include any of the following:

Read more about treatments for spondylitis or explore the many treatments available.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 65,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Are you, or someone you care for, living with psoriatic spondylitis? Share your experience in the comments below, or start a conversation by posting on MySpondylitisTeam.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

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