Psoriatic Arthritis

8M

Americans are estimated to have psoriasis, and 10-30% of those people also develop psoriatic arthritis.

30-50

Psoriatic arthritis usually develops between the ages of 30 and 50.

41%

of those diagnosed with psoriasis had not received a previous PsA diagnosis, suggesting underdiagnosis of patients in dermatologic practices.

What is psoriatic arthritis (PsA)?

Psoriatic arthritis is an autoimmune condition. Autoimmune conditions occur when the body’s immune system mistakes its own tissues for foreign invaders, such as bacteria or viruses. The confused immune system springs into action, seeking out to destroy the “invaders” in the tissues. 

In the case of psoriatic arthritis, the immune system attacks healthy cells and tissue. This results in chronic joint pain and inflammation and the overproduction of skin cells.

Psoriatic arthritis is a form of arthritis that affects people who have psoriasis, which is a skin condition that involves your white blood cells mistakenly attacking your skin cells. This attack results in your body’s overproduction of skin cells, which is what causes the common symptom of psoriasis: red, scaly patches on the skin.

Who is affected?

Anyone can be diagnosed with psoriatic arthritis. The condition is generally diagnosed between the ages of 35 and 45. [1]

Doctors aren’t sure about what causes psoriatic arthritis, but believe that a combination of genetics and environment are responsible. Other factors like family history, physical trauma, and medical conditions like psoriasis may influence your level of risk as well. [2] 

What happens in your body?

Common symptoms of psoriatic arthritis include: [2]

  • Stiffness, pain, and tenderness in one or more joints
  • Swollen fingers and toes, which can resemble sausages
  • Lower back pain
  • Fatigue
  • Small depressions in the nails or detachment from the nail bud

Symptoms of psoriatic arthritis can resemble other conditions, such as rheumatoid arthritis. But some aspects of psoriatic arthritis that are different from other conditions are pitting or flaking nails and tenderness in the soles or heels of your feet.

The condition can affect joints on one or both sides of the body. [2]

 

How do I know if I have psoriatic arthritis (PsA)?

It is important to get an accurate diagnosis as quickly as possible to make sure that the condition does not worsen. The best way to do this is by visiting your doctor and, if possible, getting a referral to visit a rheumatologist, a doctor with specialized training in treating psoriatic arthritis. 

Some ways that your doctor can assess whether you have the condition is through a physical examination or lab tests (such as imaging tests).

How is it treated?

There is no known cure for psoriatic arthritis (PsA), but integrative interventions have shown to reduce pain and discomfort and improve quality of life by slowing the condition’s progression and easing the severity of symptoms. [3] 

Integrative interventions offer a holistic approach to treatment. Instead of just conventional medicine, integrative treatments combine conventional medicine with nutritional tools, mind-body medicine, and manual medicine for a holistic approach to treating psoriatic arthritis (PsA). 

For those new to integrative medicine, learn more here

Conventional Medicine

Many people with psoriatic arthritis find that certain medications work for them and others do not. So, in order to find an effective conventional treatment, people with psoriatic arthritis often work with their doctors to determine which medication works best with their body and needs. 

With the right medication, it is possible to manage symptoms and prevent the rapid worsening of the condition. Before starting to take any medication, be sure to ask your doctor about possible side effects. And if you notice any of the side effects once you start your treatment, let your doctor know as soon as possible.

Examples of conventional treatments:

  • Non-steroidal anti-inflammatory drugs (common name: ibuprofen), or NSAIDs, are the most commonly used treatments for inflammation and pain. [2]

  • DMARDs (such as methotrexate) can slow the progression of psoriatic arthritis and prevent permanent damage to the joints and other tissues. [2]

  • Biologics (also known as biologic response modifiers) are a class of drugs that can target specific parts of the immune system that trigger inflammation and produce joint damage. [2]

  • Cortisone injections (also called corticosteroids) are steroid drugs that can be taken by injection, and may help to reduce psoriatic arthritis-related inflammation in targeted areas. [2]

  • Joint replacement surgery involves the replacement of damaged joint surfaces with metal or plastic parts to relieve pain and improve mobility. It is considered to be a ‘last resort’ treatment for psoriatic arthritis. [2]

Mind-Body Medicine

Research shows that gentle, low-intensity mind-body treatments can help PsA patients with mobility, mood, decreased pain, and more. There are a wide variety of mind-body treatments for psoriatic arthritis, ranging from deep breathing to aqua-therapy.

When living with chronic pain, engaging in regular movement and exercise may feel difficult and unnecessary. But doing so can actually improve your symptoms. 

Before starting a physical exercise regimen, consult with your doctor about what might be the best activities for you and your body.

Examples of mind-body medicine:

  • Tai chi, a mind-body exercise that originated from China, incorporates slow, gentle movements with breathing exercises. Research conducted by the Hartford Hospital found that tai chi brings emotional wellbeing, improved strength, and improved balance to individuals with chronic pain.

  • Yoga comes in many different styles, often engaging both the body and the mind through controlled breathing and stretching. Researchers have concluded that yoga therapy may help sedentary individuals with arthritis safely increase physical activity, and improve physical and psychological health.

  • Aquatic exercises such as swimming and water aerobics strengthen your core. A study found that water-based exercises may have benefits for improving pain management for rheumatoid arthritis patients.

  • Weight management and healthy nutritional intake are key in reducing health risks. A study from the National Institute of Health found that weight management from diet and exercise are beneficial for alleviating pain. 

  • Relaxation therapies like deep breathing techniques, meditation, and biofeedback can help patients ease anxiety and better manage chronic pain. A study demonstrated that mindfulness programs produced significant improvements in anxiety, depression, cognitive psychosocial abilities, and overall functioning.       

Manual Medicine

Manual treatments are administered by certified therapists, using physical pressure and stimulation on the body to reduce psoriatic arthritis symptoms. Treatments can vary in intensity and incorporate other elements such as heat and aromatherapy to enhance relief. 

Examples of manual medicine:

  • A widely-adopted Chinese treatment administered by certified acupuncturists who insert very thin needles at strategic points on the body to support overall wellness. Research demonstrated that acupuncture can improve pain management for patients experiencing chronic pain.

  • Licensed massage therapists use different techniques, like shiatsu, hot stone, and Swedish massage, to provide temporary pain relief. A Mayo Clinic study concluded that massage therapy is particularly helpful for muscle pain, and that it can also help reduce anxiety. 

  • Physical therapy can help with physical strengthening, mobility, and overall functionality. A study conducted by researchers in Sweden found that physical therapy techniques were suitable for addressing musculoskeletal conditions as well as with chronic back pain.

  • Osteopathic manipulative treatment, or OMT, is a form of manual therapy used by osteopathic physicians (DOs). A study published in The New England Journal of Medicine demonstrated that osteopathic manual care had similar clinical results to standard medical care, but required fewer medications.

Nutritional Tools

Nutrition plays a crucial role in your overall health, and is a tool you can use to combat joint damage, reduce inflammation, and manage other psoriatic arthritis symptoms. 

Just like with conventional, mind-body, and manual medicines, there is not one ideal treatment for every PsA patient. When selecting nutritional tools to treat your condition, it is best to consult with your doctor or work with a dietitian, naturopath, or nutritionist to find out the best diet for you. 

Examples of nutritional tools:

  • Anti-inflammatory diets

    • Anti-inflammatory diets include nutrient-dense foods that contain antioxidants and intend to reduce inflammation in the body. A popular anti-inflammatory diet is the Mediterranean diet which has been shown to reduce signs of inflammation.

  • Plant-based diets

    • Vegetarian and vegan diets have shown to promote gut health, which may have an anti-inflammatory impact. A study conducted by the Physicians Committee for Responsible Medicine demonstrated that plant based diets improve joint pain, tenderness, and swelling. 

  • Elimination diet

    • While some foods can help reduce symptoms, other foods may trigger them. An elimination diet, which is an eating plan that eliminates certain foods or food groups believed to be causing negative bodily reactions, can help you figure out which foods are triggering those symptoms and bring you closer to your ideal diet.

  • Fish

    • Research suggests that eating fish may reduce joint inflammation for those with rheumatoid arthritis. 

  • Fruits and Vegetables

    • Fruits and vegetables have antioxidants, which support your immune system and may fight inflammation. 

  • Nuts

    • Nuts are rich in healthy fat, protein, and fiber, and help fight inflammation.

  • Beans

    • Beans (like red, pinto, navy, and black beans) are rich in fiber and protein, and are full of both antioxidants and anti-inflammatory properties.

  • Olive Oil

    • This heart-healthy ingredient contains healthy fat, antioxidants, and oleocanthal, an anti-inflammatory compound.   

  • Onions

    • These simple, flavor-rich vegetables are packed with antioxidants and may help reduce inflammation, improve heart health, and help control cholesterol levels.

  • Fiber

    • Fiber is found in foods like beans, whole grain breads, and fresh vegetables. It makes you feel fuller for longer and boosts digestive health. It also may help reduce inflammation.

  • Fish oils

    • Fish oils may reduce inflammation. A study found that psoriasis patients who consumed dietary fish oil as part of their diet reported ideal and improved health status.

  • Gamma linolenic acid (GLA)

    • Gamma linolenic acid is mostly found in plant seed oils like borage seed, evening primrose, and blackcurrant seed oil.                  

  • Turmeric 

    • Turmeric is a spice from the turmeric plant that has anti-inflammatory properties. A  study indicated that turmeric can be used as a source for alleviating chronic pain.

  • Folic Acid

    • Folic and folinic acid supplements have been shown to improve liver function and ease gastrointestinal intolerance (the digestive system’s difficulty processing certain foods, which can lead stomach pain and bloating). Go to Mayo Clinic for recommendations on healthy consumption of folic acid. 

  • Vitamin D

    • Vitamin D supplements are good for bone health, and they can also help keep the immune system functioning properly. Research found that vitamin D supplementation was able to improve pain levels for psoriasis patients.

  • Antioxidants

    • Selenium supplements can help keep your immune system functioning properly and prevent cell damage (also known as oxidative stress).

    • Other antioxidants that can help prevent cell damage and keep the body in a balanced state.

  • Probiotics

    • Studies show that probiotic supplements may help improve gut health and even lead to lower levels of inflammation for psoriatic arthritis.

  • Pomegranate

    •  A study demonstrated that the antioxidant quality of pomegranates may ease symptoms such as tender joints.

  • Green tea extract 

    •  A study showed that green tea extract may help reduce overall joint inflammation and damage for psoriasis patients. 

  • [1] About Psoriatic Arthritis. https://www.psoriasis.org/about-psoriatic-arthritis. Accessed July 27, 2020. 
  • [2] Psoriatic arthritis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076. Published September 21, 2019. Accessed July 27, 2020. 
  • [3] Roger-Silva D, Natour J, Moreira E, Jennings F. A resistance exercise program improves functional capacity of patients with psoriatic arthritis: a randomized controlled trial. Clin Rheumatol. 2018;37(2):389-395. doi:10.1007/s10067-017-3917-x 
  • [4] Arthritis Foundation. Arthritis By the Numbers. 2019; v3; 4100.17.10445 
The information on this page is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek medical advice from your physician or health provider for your specific needs.