Psoriatic Arthritis

Written by Dr.Claire Arcidiacono, ND

For further questions or concerns email me at [email protected]

In our last blog we completed our lupus discussion. This week we will be discussing another autoimmune disease called psoriatic arthritis. Psoriatic arthritis is a type of arthritis that occurs in individuals affected by psoriasis. In fact, psoriatic arthritis occurs in up to 30% of people with psoriasis. While in most people the skin changes of psoriasis precede the arthritis in up to 15% of individuals the psoriatic arthritis occurs before the rash. † (1)

Since psoriatic arthritis is an inflammatory disorder, its symptoms, include joints that are red, warm to the touch and joints that are swollen, stiff and there is often pain. In 70% of cases there is what is referred to as “asymmetrical oligoarthritis” which just means that the inflammation affects 2-4 joints during the first 6 months of the disease. Interestingly in 15% of cases the arthritis is symmetrical throughout the joints. In addition to causing joint pain a classic symptom of psoriatic arthritis is a swelling of the entire finger and or toes. This phenomenon is known as dactylitis. (2) Over time psoriatic arthritis may lead to arthritis mutilans which is a deformity of the joints that looks like a pencil in a cup on an X-ray.†  See Picture (3)

In addition to affecting the fingers and toes there can also be pain in the sacrum caused by sacroiliacs or spondylitis. Pain can also occur in the ankles. † (2)

Psoriatic arthritis is arthritis that occurs in an individual who has the condition psoriasis and thus symptoms of psoriasis are seen in addition to the joint symptoms. Psoriasis is an autoimmune condition that results in scaly skin, lesions that are normally present over the scalp, natal cleft, elbow and umbilicus. (4) Please see the added picture. † (5)

Psoriasis can also affect both the nails and even the nail beds. It can cause visible changes in these structures such as pitting, ridging of the nails, onycholysis and hyperkeratosis. It can also cause the nails to separate from the nail bed. (6) As a consequence of psoriatic arthritis being an autoimmune condition just like we saw in RA and lupus we can see some systemic symptoms. An example of one such symptom is fatigue. The fatigue is not corrected by sleep and may persist for days or weeks. (7) As with any autoimmune disorder there may be periods of remission and periods of “flare up” where the symptoms become less/more severe in intensity. †

One risk factor for developing psoriatic arthritis is having a peptide known as human leukocyte antigen (HLA) B27. (8)  Both psoriasis and psoriatic arthritis are usually considered to be genetic disorders that have been triggered by something in the environment. (9)  Flare ups can be triggered by stress as well as certain medications. Just like with other autoimmune conditions “bad guys” such as bacteria or yeast can increase the risk of both developing the condition or increase the risk of a flare up.  For example, studies have found an association between staphylococcus aureus, Malassezia and even Candida. † (10).

Nutritionally a vitamin D deficiency has been found to be associated with severe psoriasis and psoriatic arthritis. (11)  Additionally, being overweight or obese is an important risk factor for psoriasis and psoriatic arthritis. (12) As I spoke about in my blogs regarding lupus the standard American diet also called a western diet is also a risk factor for autoimmune disorders such as psoriatic arthritis. (13) Lastly once again as we spoke about during our lupus discussion is the interesting topic of leaky gut. As I stated previously leaky gut is associated with autoimmune disorders such as psoriasis and psoriatic arthritis. (14).  While there may be less common risk factors that can cause a flare up of psoriatic arthritis in this blog, I have just reviewed the most common. †

Several conditions can mimic psoriatic arthritis and must be ruled out before a diagnosis can be made. They include but are not exclusive to the following: Rheumatoid arthritis, osteoarthritis, gout, lupus and irritable bowel disease associated arthritis. † (15)

When working with psoriatic arthritis just like with any other autoimmune disorder we want to work on the underlying autoimmune aspect. By now in our series some of these suggestions will sound familiar to you. That is because as you can see, I only make suggestions that work either by showing studies, and by both looking at the research and my own clinical experience. †

WAYS TO MANAGE PSORIATIC ARTHRITIS:

1. Diet: Working on getting to a healthy weight can help eliminate this risk factor and even help reduce symptoms of the disease after it occurs. (16) A Mediterranean diet has been found to help with autoimmune disorders. (17) In one study the Mediterranean diet helped reduce psoriasis symptoms by up to 29%! † (18)
2. Vitamin D3 has been found in studies to be very important in the treatment of both psoriasis and psoriatic arthritis. (19) Please see Invite’s D3 1000, D3 3000, Liquid D and even our Immunity Hx! †
3. Zinc has been found in studies to help with flare ups by reducing pain, inflammation and stiffness. Zinc has also been found to increase mobility. (20). Please see Invite’s Zinc lozenges, Zinc 30mg and our Immunity Hx. †
4. Turmeric has been found to help with the swelling and pain of psoriatic arthritis. (21). Please see Invite’s Biocurcumin, and Curcumin blend.†
5. Green lipped muscle has been found in studies to help modulate the immune system which helps with any autoimmune disorder. (22) In practicality I can say that it is very effective at reducing pain and inflammation. Please see Invite’s Inflammune. †
6. Ginger has been found to help with both the inflammation and pain associated with autoimmune disorders such as psoriasis and psoriatic arthritis. (23) Please see Invite’s Turmeric with Ginger†
7. Reduce stress – As we all know stress can make any chronic condition worse. By working to reduce this stress it can help reduce the risk of a flare up of the autoimmune disease.
   1. Magnesium has been found to reduce stress. (24) Please see Invite’s line of magnesium products.†
   2. L-theanine has also been found in studies to reduce stress. (25) See Invite’s L-theanine. †
   3. Fish oil is amazing for any autoimmune disorder since it helps reduce inflammation (26) and can even be helpful for stress. (27) Please see Invite’s Fish oil or Krill oil†
8. Treat leaky gut – As we know leaky gut is a huge risk factor for any autoimmune. Supplements such as probiotics (28) can be very helpful in addressing this. For more information see my digestive health series! †

Catch Dr.Claire’s Digestive health series here–>DIGESTIVE HEALTH PART 10: ANAL FISSURES, FISTULAS & LEAKY GUT

While other supplements can be helpful, I have covered the ones I consider most important. To determine which supplements and dietary changes are best for you it is important to talk to an Invite nutritionist. Next week we will be discussing Gout. †

REFERENCES

1. Ritchlin, CT; Colbert, RA; Gladman, DD (March 2017). “Psoriatic Arthritis”. New England Journal of Medicine (Review). 376 (10): 957–70. doi:1056/NEJMra1505557. PMID 28273019. S2CID 43867408.
2. Amherd-Hoekstra A, Näher H, Lorenz HM, Enk AH (May 2010). “Psoriatic arthritis: a review”. Journal of the German Society of Dermatology. 8 (5): 332–9. doi:1111/j.1610-0387.2009.07334.x. PMID 20015187. S2CID 25484225.
3. https://en.wikipedia.org/wiki/Arthritis_mutilans
4. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, et al. (May 2008). “Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics”. Journal of the American Academy of Dermatology. 58 (5): 826–50. doi:1016/j.jaad.2008.02.039. PMID 18423260.
5. https://en.wikipedia.org/wiki/Psoriasis#cite_note-Menter2008-3
6. Ritchlin, CT; Colbert, RA; Gladman, DD (March 2017). “Psoriatic Arthritis”. New England Journal of Medicine (Review). 376 (10): 957–70. doi:1056/NEJMra1505557. PMID 28273019. S2CID 43867408.
7. Davidson, Stanley, Davidson’s principles and practice of medicine, Churchill Livingstone/Elsevier, p. 1096, 2010. ISBN 9780702030857. Accessed 2016-11-12.
8. https://en.wikipedia.org/wiki/HLA-B27
9. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, et al. (May 2008). “Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics”. Journal of the American Academy of Dermatology. 58 (5): 826–50. doi: 1016/j.jaad.2008.02.039. PMID 18423260.
10. Fry L, Baker BS (2007). “Triggering psoriasis: the role of infections and medications”. Clinics in Dermatology. 25 (6): 606–15. doi:1016/j.clindermatol.2007.08.015. PMID 18021899.
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486909/
12. Prieto-Pérez R, Cabaleiro T, Daudén E, Ochoa D, Roman M, Abad-Santos F (August 2013). “Genetics of psoriasis and pharmacogenetics of biological drugs”. Autoimmune Diseases. 2013 (613086): 613086. doi:1155/2013/613086. PMC 3771250. PMID 24069534.
13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034518/
14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767453/
15. Davidson, Stanley, Davidson’s principles and practice of medicine, Churchill Livingstone/Elsevier, p. 1096, 2010. ISBN 9780702030857. Accessed 2016-11-12.
16. Snekvik I, Smith CH, Nilsen TIL, et al. Obesity, Waist Circumference, Weight Change, and Risk of Incident Psoriasis: Prospective Data from the HUNT Study. J Invest Dermatol. 2017;137(12):2484-2490. doi:10.1016/j.jid.2017.07.822
17. Phan, C.; Touvier, M.; Kesse-Guyot, E. et al. Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results From the NutriNet-Santé Cohort.JAMA Dermatol. 2018;154(9):1017-24. doi:10.1001/jamadermatol.2018.2127
18. Phan C, Touvier M, Kesse-guyot E, et al. Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results From the NutriNet-Santé Cohort. JAMA Dermatol. 2018;154(9):1017-1024. doi:10.1001/jamadermatol.2018.2127
19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486909/
20. https://pubmed.ncbi.nlm.nih.gov/7002197/
21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750830/#:~:text=Practical%20Applications&text=This%20study%20found%20that%20acupuncture,joints%20afflicted%20with%20psoriatic%20arthritis.
22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1388237/
23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9654013/
24. https://www.ncbi.nlm.nih.gov/books/NBK507250/
25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836118/
26. https://pubmed.ncbi.nlm.nih.gov/12480795/
27. https://www.health.harvard.edu/mind-and-mood/omega-3s-for-anxiety#:~:text=Researchers%20found%20that%20people%20who,biological%20effects%20in%20the%20body.
28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864899/

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