This lady has been getting back pain on and off for a long time! Her low back is tender to touch and she also gets pain in other joints, including her hands and fingers.
When she has manual therapy she finds it uncomfortable and she does not get as much relief from treatment has some other patients do.
She has some red scaly patches on the elbows and similar areas elsewhere on her torso. She has psoriasis!
Psoriasis is mainly known as a skin condition but approximately 20% of patients with psoriasis will also get joint pains, known as psoriatic arthropathy.
Patients with psoriasis will need a variety of different treatments depending on the severity of the condition. Patients with a few small patches of psoriasis may only need steroid cream. However, patients with more generalised psoriasis may need to have ultraviolet light treatment. Patients who are experiencing psoriatic arthropathy may need to suppress their immune system with disease modifying antirheumatic drugs, such as methotrexate. In recent times biologic medications have become available which can be more effective for some patients.
Patience with psoriasis should keep active, according to the Psoriasis Association.
Patients who have severe psoriasis are more likely to develop problems with their cardiovascular system, and are more at risk of developing aortic aneurysms. These patients should possibly have an abdominal ultrasound scan to check for this.
In summary: Psoriasis is a common skin condition. But it can also cause joint pain in some patients, and this may be why some patients get back pain. The condition tends to be recurrent. The advice is to try and keep active and use whatever medical treatment appears to be most appropriate. Unfortunately, manual therapy may not be as helpful for these patients has some other patients.
References:
2. Fleming J, Seymour M. Psoriatic arthritis. BMJ 2010;341(c5501, doi:10.1136/sbmj.c5501
3. Jobling R. Psoriasis. BMJ 2007;334(7600):953-954, doi:10.1136/bmj.39184.615150.802