Ankylosing spondylitis and psoriatic arthritis

Signs that need assessment

• Back pain that persists, especially when it begins at a young age.
• Morning stiffness and pain at night, relieved by movement.
• Pain and swelling (edema) of the joints.
• Swelling of a whole finger or heel pain.
• Psoriasis on the skin or changes of the nails.

Psoriatic arthritis can appear even before psoriasis is visible. Not all back pain is inflammatory; the pattern of symptoms and accompanying signs matter (see chronic back pain). Inflammatory back pain is characterized by gradual onset before age 45, duration over three months, worsening with rest and improvement with exercise, unlike mechanical pain that increases with load.

What differs in axial spondyloarthritis and psoriatic arthritis

In axial spondyloarthritis, inflammation is concentrated mainly in the sacroiliac joints, between the pelvis and the spine, and in the spine. Over the years, chronic inflammation can lead to new bone formation and fusion of the vertebrae (ankylosis), which makes the spine stiffer. At first, the X-ray may be normal. The term “non-radiographic” is used when the characteristic changes are not seen on X-ray, but clinical assessment or magnetic resonance imaging may support the diagnosis.

Psoriatic arthritis has several forms. It may affect a few joints, many of them, the fingers or the spine. Inflammation where a tendon attaches to bone is called enthesitis; swelling of the whole finger, like a “sausage”, is called dactylitis. These features help to distinguish it from osteoarthritis (osteoarthritis) and other forms of arthritis (rheumatoid arthritis, gout). Involvement of the nails (pitting, separation) is a possible indicator.

How the diagnosis is made

The rheumatologist reviews symptoms and family history and examines the spine, joints and skin. Inflammatory markers (ESR, CRP), joint ultrasound or imaging of the sacroiliac joints may be recommended. A normal result of inflammatory markers does not always exclude the disease. HLA-B27, a genetic marker present in most patients with ankylosing spondylitis but also in part of the healthy population, does not establish the diagnosis on its own. X-ray or magnetic resonance imaging may be recommended at another center as appropriate, and we interpret the results.

Treatment and why it differs by form

Treatment aims to reduce inflammation and preserve mobility and function. It includes adapted activity, physiotherapy and medicines chosen for the form of the disease: nonsteroidal anti-inflammatory drugs, disease-modifying drugs (DMARDs) for peripheral involvement and, when disease stays active, biological therapy (for example anti-TNF). Relief of pain and control of the inflammatory process are linked aims but not identical; drugs used for peripheral joints do not have the same effect on axial inflammation. So the choice is made not by the intensity of pain alone, but by the site and activity of the disease, damage and accompanying manifestations.

Skin involvement, eye inflammation (uveitis) or inflammatory bowel disease can influence the choice of therapy. Before some treatments that affect immunity, assessment for infections and a monitoring plan are needed. Exercise preserves mobility, while drug therapy targets inflammation; they complement each other.

What you can do every day: exercise and protecting function

In spondyloarthritis, movement is part of treatment and not merely general advice. Inflammation tends to cause stiffening, while regular stretching and strengthening of the muscles of the back, hips and chest preserve the mobility of the spine and rib cage. Daily exercise adapted by the physiotherapist is usually recommended, along with low-impact activities such as swimming or walking. Exercise is easier after a warm shower, when morning stiffness has eased. Movement helps because it stimulates circulation in the sacroiliac joints and spine and limits loss of flexibility, but it does not replace drug therapy when the disease is active.

Posture matters. A low pillow, breaking up long sitting with stretching pauses every 30–45 minutes and an ergonomic workstation reduce stiffening. Smoking is associated with higher disease activity and faster progression of structural changes, so quitting is one of the most useful interventions. Regular physical activity also lowers cardiovascular risk, which is slightly higher in chronic inflammatory disease. Maintaining a healthy weight matters because overweight is linked to higher disease activity and a weaker response to some drugs.

Nonsteroidal anti-inflammatory drugs are taken with food, at the lowest effective dose and under guidance, because they can irritate the stomach and require particular care in people with hypertension, heart disease or kidney disease. Do not combine two anti-inflammatories at once. If pain increases unusually or new symptoms appear, such as a red painful eye, tell your doctor rather than raising the dose yourself.

How to prepare for the rheumatology visit

A good visit rests on an accurate history. Note when the pain started, what relieves or worsens it (rest or movement), how many minutes morning stiffness lasts, whether it wakes you at night and in which joints or areas it is felt. Mention psoriasis, nail changes, episodes of red eye, chronic diarrhea with blood or inflammatory bowel disease, and relatives with spondylitis or psoriasis. Bring earlier tests and imaging and the list of medicines you take, including over-the-counter anti-inflammatories and supplements.

Questions worth asking: what is my form of the disease and how active is it; what are we aiming for with treatment; what tests are needed for monitoring and how often; which signs call for quick contact; which exercises are suitable; how do the medicines affect pregnancy plans or vaccinations. Do not be discouraged if improvement does not come at once: some drugs need weeks or months to reach full effect, and assessment uses clinical measures of activity, not only the pain on the day of the visit.

What is assessed during follow-up

The rheumatologist follows not only pain but also stiffness, swelling, fatigue, function and tests. Pain can persist even when inflammation has fallen, for example from structural damage or another problem; this is a reason to reassess the cause, not automatically to add immunosuppressive treatment. A good plan helps you tell a possible flare from an infection or mechanical injury and know when to contact the team. Stopping smoking and controlling cardiovascular risk factors are part of long-term care. Reviews take place every 6 months to a year, or sooner when the doctor considers it reasonable. Report infections or a planned pregnancy and do not change treatment on your own.

Care at Tirana Polyclinic: we offer rheumatology consultation, joint ultrasound and coordination with physiotherapy as needed. We interpret tests and imaging performed at other clinics for diagnosis and follow-up.