Psoriatic Spondylitis: another label to confuse you?

By Dr Irwin Lim, Rheumatologist

Here's a nice example of sacroiliitis on an Xray of my patient's pelvis. Grade 3 on both sides with erosions and irregular joint lines. Pretty classic.

Sacroiliitis = Inflammation of the Sacroiliac joints. It can only be inferred on X-rays late in the disease after the inflammation has led to irreversible damage.

This finding leads to the diagnosis of Ankylosing Spondylitis

Yes but the more accurate label (probably) in this particular patient is Psoriatic Arthritis.

It's a gentleman who's suffered for years with some skin manifestations of psoriasis as well as some nail abnormalities (read about these nail changes). Treatment had consisted of topical steroids.

The aches in his hands and feet, the heel pain, & the tender chest wall were largely ignored. He never really mentioned it to his dermatologist (until now).

And he doesn't even have significant back pain currently.

But he did 20 years ago as a young 20 year-old. It was always considered due to a sporting incident and he's needed to live with a "weak" back being careful not to trigger an episode.

I just wanted to highlight these overlapping diseases. Psoriasis & Ankylosing Spondylitis. They are grouped together as spondyloarthritis and it can be confusing.

Rheumatologists may use different ways to classify the array of symptoms & signs our patients present with. The terms used may actually differ from doctor to doctor, from specialist to generalist, from country to country. In some places like Australia, it matters to the rheumatologist as it affects subsidised access to different medications.

But, I'm not so sure it matters to the sufferer. Sure, some name for the disease is important. Labels, while potential confusing, have a place.

But ultimately, the problem's the pain and stiffness and reduced quality of life. Most would just want it sorted out.