Psoriasis and Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: May 2020 | Last updated: March 2021

There are various conditions or diseases that occur at the same time as conditions on the AxSpA spectrum. These are called comorbid conditions. Some of these are more common than others, and early diagnosis of these disorders can help you get prompt treatment and improve symptoms and quality of life.

Psoriasis is one of these comorbid conditions. It cannot be treated without a doctor, so early diagnosis can help you get earlier treatment and improve symptoms.

What is psoriasis?

At its most basic, psoriasis is a chronic autoimmune skin condition.1 It causes areas or patches of pink or thick red skin, and sometimes silver-colored scales. On people with darker skin, the patches may be darker or a purple or gray color.2 These patches usually occur on the elbows, knees, scalp, lower back, face, palms, and soles of the feet, but can also be seen on other areas.1 Less commonly, it can occur in the mouth or on fingernails or toenails.1

There are different kinds of psoriasis, but the most common is plaque psoriasis.1 It affects 80 to 90 percent of people with psoriasis.2 This kind of psoriasis is the type mentioned above, with the patches of raised and discolored skin. The patches can be itchy or painful, and even crack or bleed.

Psoriasis often occurs with conditions on the AxSpA spectrum. PsA typically affects other joints like those at the ends of fingers, or the wrists, knees, or ankles but can affect the spine as well.3

Why psoriasis occurs

Psoriasis is an autoimmune disease. This means a person’s immune system is working overtime and mistakenly attacks the tissues of the person’s own body.1 The exact cause is not known, but the immune system components, as well as genetics, play major parts in its development.4

How is psoriasis treated?

Psoriasis has a recognizable appearance and can often be diagnosed by a primary care doctor. However, sometimes it can be mistaken for other skin conditions, so it’s always a good idea to get any skin condition examined by a dermatologist, who specializes in skin conditions. This is especially true if you’re living with a condition on the AxSpA spectrum. Because both conditions are associated with the immune system and commonly coexist, you want to make sure you’re getting an accurate diagnosis.

Usually a physical exam and a medical/family history are all that’s needed to diagnose psoriasis; sometimes a small piece of skin is biopsied and looked at under a microscope to confirm that it’s psoriasis.

Treatment varies and depends on the severity of the psoriasis, the extent of the condition, and where it is on the body. What works for one person with psoriasis might not work for another, so it’s good to remember not to compare treatment plans.

Treatment can include:5

  • Biologics, given by injection or intravenous (IV) infusion
  • Systemic treatments, or prescription drugs taken orally or by injection that work throughout the body
  • Light therapy (phototherapy) under medical supervision in a doctor’s office
  • Oral tablets that inhibit specific molecules associated with inflammation
  • Topical treatments applied to the skin

Prior to starting treatment for psoriasis, you might want to have your rheumatologist consult with your dermatologist to make sure that there will not be any interactions between your AxSpA treatment and psoriasis treatment. Managing two separate conditions means being aware of how they and their treatments can affect each other, and your treatment team will work together to find the best comprehensive treatment plans for you.

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