Hello,
I am doing some research into my PsA and attempting to find links between this and the chronic back pain I have had for many years. I was wondering if anyone has psoriatic spondyloarthritis, if so, what are the symptoms and treatment they may be having?
Thanks,
Nicole 
Hi Nicole
Given the definition of spondyloarthritis ā¦
What is Spondyloarthritis?
Spondyloarthritis is an umbrella term for inflammatory diseases that involve both the joints and the entheses (the sites where the ligaments and tendons attach to the bones). The most common of these diseases is ankylosing spondylitis. Others include reactive arthritis, psoriatic arthritis and enteropathic arthritis, which is associated with the inflammatory bowel disease.
The Spondyloarthritis Family | Arthritis Foundation
ā¦ so I guess all of us here have Psoriatic Spondyloarthritis! PsA can be in your spine. Ankylosing spondylitis is a separate disease of the spine, with its own distinctive characteristics. How they distinguish PsA in the spine from AS in the spine I donāt know. But from the little I do know, Iām guessing itās something about location and extra bone growth.
Iām curious: is your back pain mostly above the waist or below?
Hello Seenie,
The term comes from an article I read in Rhematoligy Network. Hereās the definition, āPsoriatic spondyloarthritis forms part of the spondyloarthritis spectrum, between peripheral-only psoriatic arthritis and ankylosing spondylitis. Also, although it is less severe radiographically than ankylosing spondylitis, psoriatic spondyloarthritis has a similar disease burden in terms of most indices, according to results of a single-center, cross-sectional observational study conducted among consecutive psoriatic arthritis and ankylosing spondylitis patientsā.
Hereās the weblink if youāre interested in reading the entire article http://www.rheumatologynetwork.com/news/psoriatic-spondyloarthritis-burden-similar-ankylosing-spondylitis
My back pain has been with me for just over 20 years. My disc from L3 to S1 have severaly degenerated, the facets now pinch the nerve endings and as a result I pretty much have constant lower back pain with sciatica at times. Range of movement in my spine is much less than it used to be and reduction in my neck movement has also become an issue. This together with PsA diagnosis which is active at the moment makes for very painful days.
So I am interested to know if anyone as you say has AS or PsA in their spine and the symptoms and/or treatment.
Nicole
Itās quite common, Nicoleā¦I had pain and stiffness in my neck and lower back in my late 30s/early 40s. I had back therapy and the physical therapist helped me a lotā¦so much so that the pain and stiffness didnāt come back for at least 12 years. I really had high hopes Iād never have a stiff, sore back again! What a dreamer, eh? Sciatica seems to go along with the PsA back paināstiffness is pretty much the norm. Since Iāve been on Enbrel, that stiffness is minimalāexcept I have problems with numbness in my left leg occasionally, and that happens usually when I lift something too heavy (I try not to lift over 20 lbs.). I donāt remember if youāve started a biologic yet? I usually need to backup and read past discussions to remember these things about members (poor memoryābrain fog).
Yes, that is very interesting. Itās kind of like a hybrid of PsA and AS.
Nicole:
So I am interested to know if anyone as you say has AS or PsA in their spine and the symptoms and/or treatment.
Many of us have PsA in our spines. Some of us have AS too (you know who you are, LOL).
I have degenerative changes in my lower spine (L4/5) but whether or not it is PsA or simply because Iām old, I have no idea.
Letās see what others say!
Hello,
Thanks for replying. I am on methotrexate week number 6. So early days when it comes to treatment.
I really want to know some more about PsA in the spine or AS, as Iād like to take my thoughts on this to my next rheumatology appointment. I think there is a clear connection, but need to have a better understanding.
All the best,
Nicole
The classification gets confusing for us mere mortals. I canāt believe there are many folks with PsA whose spines are guaranteed to stay uninvolved. Someone who shall remain nameless (tntlamb) has posted about the classification and revisions of the classification and all I recall is that itās all up for grabs.
Additionally degeneration in the spine is very common I believe, but thatās not to dismiss it, if I had to chose Iād probably prefer a big swollen knee from PsA in terms of discomfort to constant back pain from OA or something.
You can tell Iām a know-nothing. But I pick up bits & pieces. If I suspected AS Iād document morning stiffness, I think thatās intense with AS. And range of motion in the back would likely be poor I think. And Iād flag up my concerns with my rheumy, really emphasise them. Iām not sure what else you can do.
Hello Sybil,
I have to say I agree, a swollen knee is much more preferred than a back that is constantly painful and goes into spasm at the mere change of movement.
Nicole
I had spinal degeneration on my X-ray at 36 - facet hypertrophy I think. Even at 36, that was considered normal. Those radiographic changes certainly werenāt the source of my back pain (which spontaneously resolved, to migrate instead to large and peripheral joints, then subsequently largely disappear once the old TNF was under control).
My limited understanding of the difference between spondyloarthropy and ankylosing spondilitis is in the literal sense of the words.
A spondlyarthropy implies symptoms affecting the joints of the spine. (Usually pain and stiffness, sometimes with inflammation).
Spondilitis on the other hand, REQUIRES inflammmation in the spinal joints (hence the itis). And to make it ankylosing, then there needs to be a process whereby two bones become one (e.g. fusion), or bone turns up where soft tissue should be. The most common process, as I understand it, is that ossification of the bridging ligaments (+/- tendons) occurs. So essentially, without new bone on X-ray, it canāt be ankylosing.
My understanding is that spondylarthropy is near-universal in PsA, spondylitis is common, and ankylosing spondylitis is an additional process which sometimes overlaps.
This is just my laymans understanding from what Iāve read - and diagnostic criteria and understanding of disease processes are changing all the time, so someone more knowledgeable than me can jump in any time 
Indeed. I said āin terms of discomfortā though because joints that are definitely affected by PsA summon the spectre of ongoing & possibly severe damage even when they donāt hurt that much. Whereas as you doubtless know, degenerative changes may hurt like hell but the PsA drugs wonāt be of use.
The question ādegenerative or PsA?ā can be a real devil. So you just have to keep pushing to find out if your spine issues are inflammatory. In the UK progress to biologics should be quicker for patients with AS, if that does turn out to be the case.
**I have a curved back and a twisted back! Fine a good pain doctor and back doctor. For me it required opioids and a biologic that works. Iām on my fourth biologic, pray with me it works! **
I have psoriatic arthritis with axial involvement. (Spondyloarthritis) I just had a visit with a new rheumatologist at U Penn and she gave me a great handout on treatment options - Iāll scan it and share when I get home today. But basically, there are only 6 drugs that effectively treat axial psoriatic arthritis, and of these, only 3 year the skin symptoms as well (Humira, Enbrel, and Cosentyx)
And many of us have been blown off with āItās OA, you have OA, I have OA, we all have OAā when in fact itās PsA at work.
Yes I have had it since 1982, my started with what I thought was a back sprain, that never went away no matter what, and progressiveally got worse ( pardon my spelling). In 2007 after seeing at least 15 doctors, I was finally told that Yes you do have spondyloarthritis, only they called mine Anklosing Spondylitis. Get to a rumy asap, because this only gets worse. Cought at an early stage, you hopefully wonāt end up like me.
Simple answer we all do. Its sort of a new term which ids being modified to include Axial spondyloarthritis and Peripheral Spondyloarthritis. The new terminology is being pushed mostly by Advocacy groups (leading the pack is the SAA) trying to impart the seriousness of the disease. They think it gets confused with Grandmas Rheumatism too much
I have. MRI and CAT scans show no real damage but enthesitis problems. It was really bad a few months ago but biologics are helping a bit. I find exercise hwlps with stiffness etc
Just my luck.
All this talk about back pain and arthritis, Iāve gone and put my back out. Went to bed with it aching, took some extra pain meds. Woke up this morning with complete back spam with pain running down my left leg. I canāt sit or stand. Lying down only possible on one side and my joints just seizes up when I try.
It looks like itās diazepam on the menu tonight. I just want to be pain free for one day. Boy, people donāt know how good life is without PsA.
Nicole 
Nicole, what a bummer. When I complained to my rheumatologist (she teaches residents while seeing patients) about the pain running down my leg, she snapped to the student, āBest guess?ā Student said L3/4 (I think). Doc said that itās probably not a PsA issue, but likely a disc issue. Too complicated for simple me. I go to the PsA Research Clinic next week, and I will, of course, tell them about my leg pain. Wonder what they will say?
Do you swim? I find cycling motions, floating and stretching in the pool very helpful. Even a hot tub helps.
Take care and take your meds, and I hope youāre better soon.
Previous posts have adequately covered the medical definitions so I am rather going to give a personal perspective on coping techniques and the real issues involved.
I am 65 years old,male and 6 feet 4 inches tall. I fractured L4 in a skiing accident some 15 years ago and have had serious PsA for the last 10 years with great difficulty in my hands and hips. The back pain is constant and dull but with episodes of āelectrical stormsā that cause one to yell out loud! I need not tell readers about the pain that comes with PsA.
I have taken most of the medications but have steered clear of sustained pain killers. I push myself to keep active with a small business I run, Pilates and a mental exercises to focus on the pain and ācontainā its impact on the rest of my body and the depression that comes with PsA.
Joint damage is clearly going to be a consequence - now get audible grinding sounds from lower back on occasions - but it would seem to me that a positive approach and a forced regime of exercise is preferable to being forced into a more sedentary way of life.
The real causality is the effect on those around you - my long suffering wife who gets as little sleep as me and has to cope with the short temper and screams! No easy solutions hereā¦ just lots of positive plans to do things together even if, on the day, they prove impossible to do.
This sounds like an anti medication rant but is just my experience of where drugs have not helped; my reumetologist has effectively told me to āman upā and I have decided to āgo for itā in the face of mounting pain and what seems to be a relatively fast decline in lower back mobility.
Hi Guy,
I have a son whoās 6ā4" and has a crooked backā¦IDK why his doctors didnāt notice it when he had a routine scoliosis check as a pre-teen. I mentioned it to his doctor but he said it would straighten outāhe was just growing too fast. Anyway, I can sympathize with you. Being so tall can possibly cause additional problems. Posture is sometimes a problem, IDK you, so not sure if thatās an issue.
Iām 64 and have had something like what you call āelectrical stormsā. It felt like an electrical shock and I never knew when it was going to strike! I had lots of other back problems over the years, but not from a specific injuryājust wear and tear from doing hard labor that I should have left to the men.
What I wanted to tell you is I stayed away from meds, too. I only had prednisone a couple times and an occasional aspirin or Excedrin. But, it came to the point three years ago, I just couldnāt live with the illness of PsAāit was getting the best of me. I ended up going on a biologic, Enbrel, and it made a huge difference. I felt 80% better within days and my psoriasis cleared up about 75% within a couple weeks. My back ended up āgoing outā anyway, but it got better. You donāt realize the damage thatās happening while youāre not treating your PsA. You might not realize that until itās too late. I wish I would have started Enbrel soonerā¦my back wouldnāt be so touchy and my feet wouldnāt hurt all the time. But, being on Enbrel now has protected me from further injury and helped me get through some rough painful times with my back and feet I wouldnāt be able to endure otherwise.
My rheumatologist told me if I was his sister heād make me take the meds! Plus, when I joined this site, the moderators basically told me I was nuts (in a nice but stern way) for not taking them!