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General Medical Questions
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Question : My husband was recently told there is a connection between psoriasis and back pain. Could you please explain this?
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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March 12, 2012
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A:

The connection between psoriasis and back pain is surprising to many. But 5 to 10% of patients with psoriasis develop a condition called psoriatic arthritis.

It’s odd. But when the nails are involved with psoriasis, the chances of having psoriatic arthritis go up as high as 50%. In most patients, the psoriasis comes first. Then it’s followed years later by the arthritis.

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 are:

  • Ankylosing spondylitis
  • Colitis-associated arthritis
  • Reactive arthritis

These other conditions share certain features, including involvement of only a few joints and a particular genetic marker (called HLA-B27). But they are not associated with psoriasis.

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:

  • Regular exercise
  • Anti-inflammatory medicines
  • 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.

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