From healthcentral.com
PsA can be a pain in the neck—literally—due to inflammation of the cervical joints. A mix of medications and exercise can help provide relief
You probably already know that psoriatic arthritis (PsA) causes joint pain. But what’s less commonly known—unless you are frequently experiencing it yourself—is that the condition can also cause neck pain.
“Psoriatic arthritis could potentially affect the axial skeleton, which includes the cervical and lumbar spine,” says Elena Schiopu, M.D., a professor of medicine in the rheumatology division for the Medical College of Georgia at Augusta University in Augusta, GA. The cervical spine consists of the seven vertebrae that make up the neck, while the lumbar spine consists of the five vertebrae that make up the lower back.
When psoriatic arthritis affects the neck and back, it’s sometimes referred to as psoriatic spondylitis or axial arthritis, according to the Arthritis Foundation. Statistics vary, but some research shows that up to 70% of people with psoriatic arthritis can also experience damage to the axial skeleton, according to a review published in the Journal of the American Academy of Dermatology. In only about 5% of cases, people with psoriatic arthritis just experience neck and back pain (i.e., without any additional joint symptoms), per the review.
“One of the features of axial spinal arthritis is that it typically starts in the lower spine and sacroiliac joints—where the spine meets the pelvis—and then later on will also involve the cervical spine,” says Philip Mease, M.D., a clinical professor at the University of Washington School of Medicine and the director of rheumatology research at Swedish Medical in Seattle, WA.
Determining whether PsA is causing your neck pain can help you and your health care team come up with a plan for treating it, whether that’s through medications, physical therapy exercises, or a combination.
Cause of Psoriatic Arthritis Neck Pain
When neck pain is due to psoriatic arthritis, the most likely culprit is inflammation, which also causes other types of joint pain among people with psoriatic arthritis, says Dr. Schiopu.
Psoriatic arthritis is an autoimmune disease, which occurs when the body attacks healthy tissues by releasing inflammatory chemicals called cytokines. Over time, this can cause damage to the joints, including those of the neck. “In general, inflammatory pain and stiffness gets better with movement and as the day goes by,” says Dr. Schiopu.
Symptoms of Psoriatic Arthritis Neck Pain
“Neck pain from psoriatic arthritis is nagging and impairing, and interferes with daily functioning,” says Dr. Schiopu. “People notice the pain gets better with movement, but overall, there’s still a loss of range of motion over time.”
Other symptoms of psoriatic neck pain, according to the Journal of the American Academy of Dermatology review, include:
Limited mobility
Neck (or back) pain and stiffness that lasts longer than 30 minutes
Neck (or back) pain that improves with activity and worsens after longer periods of inactivity
While axial arthritis involves the entire stretch of the spine, from the head to the neck, back, and tailbone, about 25% to 50% of people with psoriatic spondylitis also have sacroiliitis, which is pain and stiffness specifically in the sacroiliac joints (the joints where the lower spine and pelvis meet), according to the Journal of the American Academy of Dermatology review. With sacroiliitis, the pain typically lasts longer than 20 minutes, and gets worse at night.
Psoriatic Arthritis vs Osteoarthritis
Psoriatic arthritis isn’t necessarily responsible for all—or even any—of the neck pain you may be experiencing. “The neck is also a hot spot for degenerative spine disease [like] osteoarthritis,” says Dr. Schiopu.
“A classic place for degenerative arthritis to show up and start to be symptomatic, even in a patient’s 30s and 40s, is at the fulcrum point of the neck, [between the fifth and sixth cervical joints], where the most bending goes when we move our head,” adds Dr. Mease. The condition becomes even more common as you get older: According to the American Academy of Orthopaedic Surgeons, more than 85% of people over the age of 60 are affected by cervical spondylosis, or arthritis of the neck due to joint degeneration.
That’s why it’s important to get the right diagnosis for your symptoms. “When we hear about neck pain in a person with psoriatic arthritis, it’s important for us to obtain imaging, especially MRI imaging, to determine whether there’s immunologic inflammation going on versus degenerative arthritis, which is very common,” says Dr. Mease. An MRI scan can show markers of inflammation in the bones or joints, which can help doctors determine if the neck pain is caused—in part, or in whole—by psoriatic arthritis.
Treatments for Psoriatic Arthritis Neck Pain
The treatments for psoriatic arthritis neck pain follow the same guidelines as treatment for psoriatic arthritis in general, and typically include a combination of medications such as immunosuppressants and anti-inflammatory medications, as well as lifestyle strategies and physical therapy, says Dr. Mease.
Medications
Some of the immunosuppressant medications that are used to treat psoriatic arthritis include traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, which broadly suppress the immune system to keep inflammation in check. A newer subset of DMARDs, known as biologics, include drugs such as adalimumab and secukinumab which block inflammation-causing proteins. Yet another recent development, targeted DMARDs called Janus kinase (JAK) inhibitors, include medications such as tofacitinib, which also blocks certain inflammation-causing proteins, according to the Arthritis Foundation.
These immunosuppressants will only help relieve neck pain that’s caused by psoriatic arthritis, however—they won’t ease the pain that may be caused in part by osteoarthritis. “Let’s say that 50% of a person’s neck pain is due to psoriatic arthritis and 50% is due to degenerative arthritis,” says Dr. Mease. “[Immunosuppressants] aren’t going to help the pain that’s caused by degenerative arthritis.”
To help ease neck pain from a degenerative condition, your doctor may recommend over-the-counter anti-inflammatory medications such as acetaminophen.
Lifestyle Strategies
Neck pain can be more common among people who spend a lot of time in front of a computer or other screen, says Dr. Schiopu, who recommends taking frequent breaks from your digital devices and doing some stretches. If you work at a desk, use a high-backed chair to help improve your posture and ease some of the stress on your spine, she notes. If you use a screen in bed, try using a pillow with good neck support, which can help relieve some of the tension you may feel.
Heat or cold therapy can also help, adds Dr. Schiopu. Try taking a hot shower or bath after you wake up to ease any pain and stiffness or apply an ice pack to the area if you’re experiencing inflammation.
Neck Exercises for Psoriatic Arthritis
Psoriatic arthritis can affect the joints in the cervical spine, which can cause the nearby muscles to become tight and stiff, says Jonathan Yu, a doctor of physical therapy at the Hospital for Special Surgery in New York City. “Joint stiffness can be helped by stretching out some of these muscles, so the muscles can move a little bit better,” he says. “As a result, it can allow for a bit more comfort and relaxation in the joints.”
Here are a few movements to try, from Yu. With any of these exercises, stop if you feel as if you’re in pain. “You should feel more of a stretching sensation rather than a painful sensation,” he says.
Neck Forward Stretch
Starting from a seated or standing position, bend your chin into your chest until you feel a stretch in the muscles in the back of the neck. Hold the position for 10 to 30 seconds. Repeat two to three times.
Side Bend Stretch
Starting from a seated or standing position, tilt your right ear toward your right shoulder, stretching out the left side of the neck. Hold the position for 10 to 30 seconds, then repeat on the other side. Repeat two to three times on each side.
Neck Rotation Stretch
Starting from a seated or standing position, rotate your neck to the right side, then bend the neck toward your armpit. You should feel a stretch in the muscles on the left side of your neck. Hold the position for 10 to 30 seconds, then repeat on the other side. Repeat two to three times on each side.
Other Symptoms of Psoriatic Arthritis
More commonly, psoriatic arthritis causes symptoms beyond neck pain. According to the Mayo Clinic, these can include:
Eye inflammation (uveitis)
Foot pain (especially where the tendons and ligaments attach to the bone, such as at the Achilles tendon)
Joint pain and stiffness
Lower back pain
Nail pitting or denting
Swelling in the fingers and toes
Psoriatic arthritis can affect the cervical and lumbar vertebrae, triggering neck pain (also called psoriatic spondylitis or axial arthritis). This neck pain is caused by inflammation, and while it tends to improve with movement, it can still cause discomfort throughout the day. Osteoarthritis may also be a cause of your neck pain, so it’s important to get the right diagnosis. To ease some of the pain and stiffness, your doctor may prescribe immunosuppressant medication and/or recommend a physical therapist who can show you how to perform certain exercises at home.
https://www.healthcentral.com/condition/psoriatic-arthritis/psoriatic-arthritis-neck-pain
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