The prevalence of low back pain appears to be higher in people with psoriasis than in the general population, according to an analysis of national survey data.
The findings may change the way psoriasis patients are managed when they present to primary care or specialty clinics with sudden-onset back and buttock pain, said first author of the study, Dr. Nicole Thom of the division of rheumatology at Cedars-Sinai Medical Center, Los Angeles, and her colleagues (Arthritis Care Res. 2014 Dec. 2 [doi:10.1002/acr.22528]).
Using data from the 2009-2010 U.S. National Health and Nutrition Examination Survey of 6,684 adults, the researchers identified 5,103 people who had answered questions on back pain. A total of 148 had psoriasis and 5 had psoriatic arthritis (PsA).
People with psoriasis/PsA had a significantly higher prevalence of axial pain as measured using the 3-month duration criteria, compared with people without the disease (31.1% vs. 18.9%; P = .04). They were also more likely to have alternating buttock pain (7.2% vs. 2.4%; P = .03) and meet Berlin 7b and 8a criteria for inflammatory back pain (P = .04 and P = .02, respectively). The prevalence of spondyloarthritis was significantly higher in the psoriasis/PsA group when using Amor or European Spondyloarthritis Study Group criteria (14.3% vs. 1.5%; P = .001). Sudden onset of axial pain was also higher in the psoriasis/PsA group (23.3% vs. 13.0%; P = .01), the researchers reported.
“The internist or family medicine physician should include inflammatory back pain in their differential diagnosis,” the study authors suggest.
With more and more research continuing to support multiple comorbidities in psoriasis, it also raises the question as to whether rheumatologists, dermatologists, and other health care professionals should be screening for them, they said.
The work was supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and a National Center for Research Resources grant to the Clinical Translational Science Institute at the University of California, Los Angeles.