A Comprehensive Review of Complementary and Integrative Medicine Approaches to the Management of Psoriatic Arthritis

Psoriatic arthritis (PsA) may affect about 3 out of 10 people with psoriasis. PsA is recognized as a chronic inflammatory condition of the joints and can begin at any age. This condition often affects individuals between the ages of 30 to 50 and may start around ten years after psoriasis develops. However, some people can develop PsA without ever having any psoriasis symptoms, which include itchy, scaly skin. Although there is no cure or specific test to diagnose PsA, functional medicine may help assess and manage some of the underlying factors that contribute to the symptoms of PsA. This article will explore what PsA is, the symptoms associated with PsA, how it is diagnosed, and various therapeutic options to manage PsA.

What is Psoriatic Arthritis?

PsA is an inflammatory condition and is a type of arthritis that affects some people with psoriasis, which is an inflammatory condition of the skin that causes red scaly patches. PsA is similar to rheumatoid arthritis (RA) in that it can cause pain, stiffness, swelling in the joints, and other symptoms. However, unlike RA, PsA typically affects fewer joints and doesn't create antibodies. PsA comes in five different forms and can affect small joints in the fingers, toes, or both, as well as the joints in the hands, feet, and even the spine. In certain cases, it can be a severe and rare type of arthritis that affects and deforms joints, called arthritis mutilans.

This condition can also cause inflammation in various body parts, including the eyes, heart, and lungs, but it mostly affects joints, fingers, toes, and the spine. Healthcare providers can develop a treatment plan that is individualized to the patient's specific needs. Overall, PsA can be challenging to manage, but with the right treatment plan, people can live full and active lives.

Psoriatic Arthritis Symptoms

Many symptoms are associated with psoriatic arthritis. It's important to remember that not everyone with psoriasis will develop psoriatic arthritis. Psoriasis symptoms may appear before or after psoriatic arthritis. Psoriasis causes red, flaky rashes and thick, pitted fingernails.

The symptoms of psoriatic arthritis can vary between individuals, with the most common symptom being joint pain. The pain in the joints can range from mild to severe. It can be accompanied by stiffness and swelling. People with psoriatic arthritis may also notice that their joints feel warm to the touch. These symptoms may change over time, and some people may experience symptoms that come and go, while others may have more severe, constant symptoms.

Along with joint pain, psoriatic arthritis can cause other symptoms. Fatigue is another common symptom. Some people may also develop nail changes, such as pitting or thickening of the nails. Others may experience fatigue or inflammation in other body parts, such as the eyes, heart, or lungs.

If you have psoriasis and you are experiencing joint pain or other symptoms, it is important to talk to your healthcare provider. With early diagnosis and treatment, people with PsA can manage symptoms and maintain a good quality of life.

What Causes Psoriatic Arthritis?

The exact causes of PsA are still unknown. However, it's believed to be caused by a combination of genetic and environmental factors. People with a family history of either psoriasis or psoriatic arthritis may be more likely to develop the condition themselves. As mentioned earlier, some people with psoriasis may develop PsA. Psoriasis is a common precursor to PsA. In PsA, the immune system may attack healthy skin cells, leading to inflammation and skin cell growth. This immune response can also affect joints.

Although the exact causes are not known, there are some risk factors and triggers for PsA. Some risk factors include age and obesity, while possible triggers include infection, physical trauma, stress, and other unknown environmental triggers. Researchers have found some genetic markers that may be associated with PsA. However, more research is needed to understand the underlying mechanisms contributing to this condition.

Ruling Out Differential Diagnosis for Psoriatic Arthritis Patients

It's important to rule out other conditions that may present with similar symptoms to PsA. For example, Psoriasiform skin lesions can also be seen in other conditions like reactive arthritis, inflammatory bowel disease (IBD), and the syndrome of inappropriate secretion of diuretic hormone. Other conditions with similar symptoms include RA, enteropathic arthritis, spotted bone disease, and ankylosing spondylitis. Lupus erythematosus and secondary syphilis can also cause rashes similar to psoriasis but usually do not result in deformed joints like PsA. Other differentials include gout, pseudogout, osteoarthritis, reactive arthritis, and septic arthritis. It is important to properly diagnose PsA to determine the most effective management plan.

Functional Medicine Labs to Test for Root Cause of Psoriatic Arthritis

Diagnosing psoriatic arthritis can be challenging, as the condition shares symptoms with other types of arthritis. Currently, there's no single test to diagnose PsA. To accurately diagnose psoriatic arthritis, healthcare providers typically perform a physical exam, review the person's medical history, run diagnostic tests, and multiple specialists may be involved. A dermatologist may be involved to assess the skin conditions, while a rheumatologist may be considered if arthritis is the first symptom. Blood tests can look for inflammation and to rule out other kinds of arthritis, such as rheumatoid arthritis. Other diagnostic tools include X-rays, MRI scans, or ultrasound tests to look for signs of joint damage or inflammation, and a skin biopsy may be performed to confirm the presence of psoriasis.

Functional medicine labs may be utilized to assess risk factors involved with PsA and manage some underlying factors associated with the symptoms. Some functional medicine labs to consider include:

Inflammatory Markers

Elevated levels of CRP and ESR in the blood may indicate inflammation. Elevated levels of CRP may also indicate infection, a possible trigger for PsA. Since PsA is an inflammatory condition, these tests can be helpful in measuring the levels of inflammation and creating a protocol for managing the inflammation.

Antinuclear Antibodies (ANA)

ANA tests can help detect or rule out other autoimmune conditions that may cause joint pain, inflammation, or other common symptoms of PsA.

Fasting Insulin

Obesity is considered a risk factor for PsA. Insulin resistance is one root cause of obesity, and this test can be a helpful tool in assessing this risk factor.

Food Sensitivity Testing

Some people with psoriatic arthritis may find that certain foods trigger their symptoms because they can be inflammatory. Food sensitivity testing can help detect foods that may be inflammatory to these individuals.

Micronutrient Panel

Deficiencies in specific nutrients can aggravate symptoms associated with PsA. For instance, deficiencies in omega-3s may lead to inflammation, or B12 may lead to nerve and muscle issues. Assessing nutrient levels can help manage symptoms of PsA.

Working closely with a healthcare provider to diagnose and manage psoriatic arthritis accurately is a good idea. By combining conventional diagnostic methods with functional medicine labs, healthcare providers can develop a personalized management plan that addresses the underlying factors of PsA to help manage the symptoms effectively.  

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Conventional Treatment for Psoriatic Arthritis

Various treatment options are available for psoriatic arthritis, including medications, physical therapy, and lifestyle changes. Psoriatic arthritis can be a chronic condition that requires ongoing management. Conventional treatments aim to reduce inflammation, relieve pain, and slow down the progression of damage in the joints. It's important to note that management plans can vary and will depend on the severity level of the condition and individual needs. Some common conventional treatments for psoriatic arthritis include:

Nonsteroidal anti-inflammatory drugs (NSAIDs): These over-the-counter or prescription medications can help reduce joint pain and inflammation.

Disease-modifying antirheumatic drugs (DMARDs): DMARDs, such as methotrexate or sulfasalazine, can help slow down the progression of joint damage and reduce symptoms.

Biologic drugs: Biologic medications, such as tumor necrosis factor (TNF) inhibitors, target specific immune system components to reduce inflammation and control symptoms.

Functional Medicine Treatment Protocol for Psoriatic Arthritis

In addition to medical treatments and medications, there are also natural ways to help manage psoriatic arthritis symptoms. Functional medicine addresses the underlying factors that may contribute to the symptoms associated with PsA and promotes overall wellness. Functional medicine can include dietary changes, clinically relevant supplements, stress management, and other integrative approaches such as light therapy. Functional medicine usually combines these approaches and personalizes them to the patient's needs. Regular follow-ups and communication with a functional medicine practitioner are essential to monitor progress and make necessary adjustments to the management plan.

Therapeutic Diet and Nutrition Considerations for Psoriatic Arthritis

There is no specific diet for PsA. However, dietary changes may help reduce the inflammatory responses that can occur with PsA and improve overall symptoms. The therapeutic diet should include foods that are anti-inflammatory and nutrient-dense. The diet recommendations for PsA typically involve foods to incorporate and foods to avoid.

Foods to include in a therapeutic diet for psoriatic arthritis include fruits, vegetables, whole grains, and lean protein sources such as fish and legumes. These foods are abundant in nutrients such as vitamins, minerals, and antioxidants that all support overall health and may help reduce inflammation. Other foods include healthy oils such as olive oil. Olive oil has been shown to make psoriasis symptoms less severe.

Foods to avoid consist of processed foods, sugar, and saturated fats, which may increase inflammation. Individuals with PsA may also benefit from reducing their intake of gluten. Research showed that 25% of patients with psoriasis reacted to the gluten protein.

Overall, a therapeutic diet for psoriatic arthritis focuses on foods high in nutrients and anti-inflammatory foods while limiting foods that may contribute to inflammation. Working alongside a healthcare provider to develop a comprehensive and personalized management plan that includes dietary changes and other interventions as needed is important.

Supplements Protocol for Psoriatic Arthritis

Functional medicine management for psoriatic arthritis incorporates natural supplements that have anti-inflammatory and immune-supporting properties. Here are some of the supplements used in managing psoriatic arthritis and how they may help:

Omega-3 Fatty Acids

Omega 3s are an essential fatty acid with many health benefits, including anti-inflammatory effects. These anti-inflammatory properties may help reduce joint pain and stiffness and have been shown to reduce symptoms of inflammatory arthritis. The recommended dose for inflammatory arthritis conditions is 2,700 to 3,000 mg (as EPA/DHA in a >1.5 EPA/DHA ratio) per day for a minimum of 3 to 4 months as an adjunct therapy.

Curcumin

Curcumin comes from turmeric, which has potent anti-inflammatory and antioxidant effects that may help alleviate joint pain and stiffness. The dosing recommendation is 500 mg per day for inflammatory arthritis conditions.

Chondroitin

Chondroitin has been shown to help with inflammatory joint conditions such as osteoarthritis. It's also been shown to help improve psoriasis symptoms. The studies showed that it deregulated NF-κB, an important factor in skin pathology. The dosage completed in the study was 800 mg per day for two months.

Vitamin D

This nutrient is vital for immune function and bone health. Its main uses include musculoskeletal issues, chronic pain, and inflammatory disorders. Deficient levels of vitamin D have been associated with an increased risk of psoriatic arthritis. The recommended dose for inflammatory arthritis is 500 IU (as D3) with 1,000 mg calcium per day for 3-48 months as adjunctive therapy.

Vitamin B12

This vitamin is essential for nerve function. It is also commonly used for neurological conditions, neuropathy, and pain-related conditions. This nutrient may be beneficial in improving PsA symptoms if B12 deficiency is a contributing factor. The recommended dose for deficiency is 1000 mcg per day.

Ginger

Ginger is known to have anti-inflammatory, analgesic, and immunomodulating properties. While ginger has not been studied specifically for its use in PsA, The Arthritis Foundation recommends it for other inflammatory arthritic conditions like OA and RA. It might be beneficial to try it since ginger's properties may help reduce joint pain and stiffness involved with PsA. The recommended dose is 1,500 mg (as encapsulated ginger powder) per day for 12 weeks.

It's important to note that these should all be used under the guidance of a functional healthcare practitioner, as some supplements may interact with medications or have side effects. Incorporating these natural supplements into a comprehensive functional medicine management plan can effectively help manage psoriatic arthritis symptoms.

Light Therapy For Psoriatic Arthritis

Light therapy may help manage the pain and inflammation associated with PsA. Ultraviolet light therapy can be a simple and safe treatment to improve psoriasis. There are 2 types of ultraviolet light: UVA and UVB. Both are linked with cancer, but UVB is the one that may help treat psoriasis. UVB can reduce the substances that cause psoriasis and also promote regulatory T-cells that suppress autoimmune reactions. UVB exposure also stimulates the healthy production of vitamin D, which may help slow the rapid growth of the skin cells and improve the skin's barrier function and immune system.

There are different ways to get UVB light therapy. Sunlight is excellent for people with mild skin symptoms who live in sunny areas. Narrowband UVB phototherapy is a treatment done in a clinic, and it is the most common light therapy because it is very safe and effective. Patients who respond well to UVB while at the clinic can buy a home unit. The excimer laser is another option for treating small, localized psoriasis plaques. UVA light, on its own, is not effective for psoriasis and is combined with a chemical called psoralen in a treatment called PUVA.

Indoor tanning is not recommended for treating psoriasis because it can significantly advance the risk of skin cancer. The management goal for psoriatic arthritis is to find what improves both joint and skin problems with the fewest side effects. UV therapy can be a cost-effective therapy for PsA.

When to Retest Labs

Functional medicine labs can help identify imbalances and underlying factors associated with the symptoms of PsA. However, functional medicine can take time and often require ongoing monitoring and retesting to track progress. The frequency of retesting will vary depending on the individual case and the specific labs that were ordered. In general, it's recommended that labs be retested at regular intervals, usually every 3 to 9 months, to track progress and ensure the management plan has the desired effect. The specific frequency of retesting will be determined by the functional medicine provider based on an individual's needs and response to management. This process is usually collaborative with the patient to ensure that testing isn't being completed excessively while ensuring clinical relevancy and progress.

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Summary

PsA is a chronic condition causing inflammation, swelling, and tenderness in joints and other body parts. It can be challenging to properly diagnose and manage as no specific test or cure exists for this condition. Research shows that functional medicine approaches such as supplementation of anti-inflammatory herbs and vitamins may help manage PsA symptoms along with other integrative approaches such as dietary changes and light therapy. Ultimately, these management approaches can help improve the quality of life for those living with PsA. It's important to work with a qualified functional medicine practitioner to help assess your underlying conditions and personalize your protocols.