Psoriatic arthritis alternative treatment, herbs, vitamins, supplements, research
July 1 2017 by
Ray Sahelian, M.D.

Psoriatic arthritis is a chronic disease characterized by inflammation of the skin (psoriasis) and joints (arthritis). Approximately 10 to 20% of patients who have psoriasis also develop an associated inflammation of their joints. Patients who have inflammatory arthritis and psoriasis are diagnosed as having psoriatic arthritis.

Heavy alcohol consumption is associated with an increased risk for psoriatic arthritis.

Natural treatment, alternative therapy
I could only find one study. Vitamin D may be of benefit.

Subjective improvement in patients with psoriatic arthritis after short-term oral treatment with seal oil. A pilot study with double blind comparison to soy oil.
J Rheumatology. 2006. Section for Rheumatology and Gastroenterology, Institute of Medicine, University of Bergen, Norway.
To investigate effects of short-term oral treatment with seal oil in patients with psoriatic arthritis. Forty-three patients with polyarticular psoriatic arthritis were randomized to receive oral treatment for 2 weeks with either seal oil or soy oil in a double blind controlled trial. Patients were allowed to continue nonsteroidal antiinflammatory drugs (NSAID) and disease modifying antirheumatic drugs (DMARD) during the study. Forty patients completed the study, 20 in each treatment group. Patients in the seal oil group reported a significant improvement in global assessment of the disease 4 weeks post- treatment, and both groups showed a trend toward improvement in tender joint count, but the differences between the groups were not significant. There was a fall in the ratio of n-6 to n-3 fatty acids and in arachidonic acid (AA) to eicosapentaenoic acid (EPA) in serum after treatment with seal oil. Twenty-one percent of all patients had elevated values of calprotectin in feces suggestive of asymptomatic colitis. Treatment with seal oil was followed by a modest improvement in patient's global assessment of the disease and a trend towards a decrease in number of tender joints. There was a shift in fatty acid composition in serum toward a putative antiinflammatory profile. Oral treatment with seal oil may have NSAID-like effects in psoriatic arthritis.
   Comments: I wonder if fish oil supplements, krill oil, or flaxseed oil would have similar benefits, or consuming a lot of cold water fish.

Symptoms and signs
Common symptoms and signs of psoriatic arthritis include:
Feeling fatigued, reduced range of motion in the joints and feeling stiff in the morning.
Joints that are swollen and painful along with back pain.
Pain and soreness where tendons attach to bone, such as at the heel.
Pitting or separation of nails from the nail bed.
Conjunctivitis with by redness and pain in tissues surrounding the eyes.

Psoriatic arthritis treatment
Mild skin and joint symptoms of psoriatic arthritis may be treated with topical agents, ultraviolet light therapy, and nonsteroidal anti-inflammatory drugs. More severe manifestations of the disease, including progressive peripheral joint damage, spine disease, enthesitis, dactylitis, and severe skin changes, require systemic therapy. Traditional systemic drugs include methotrexate, sulfasalazine, and cyclosporine. When these medications are not adequate or not tolerated, new biologic agents, particularly anti-tumor necrosis factor (TNF) compounds, have shown benefit but they have risks and dangers.

In the last years, the introduction of biologic drugs has greatly changed the treatment of psoriasis and psoriatic arthritis. In fact, tumor necrosis factor-α blockers demonstrate an effective action in the treatment of both skin and joint manifestations, but they have some adverse effects.

Clin Exp Rheumatol. 2015. A short history of biological therapy for psoriatic arthritis. Psoriatic arthritis (PsA) is an inflammatory disease characterised by the clinical domains of arthritis, enthesitis, dactylitis, spondylitis, and psoriasis, often causing significant functional disability, loss of quality of life, and premature mortality. Prior to the introduction of targeted biologic medications, such as TNF inhibitors, the capacity to control disease activity was limited, with only modest effects noted in most patients with traditional oral medications such as methotrexate and sulfasalazine. The introduction of TNF inhibitors substantially changed the outlook of PsA patients, yielding significant response in all relevant clinical domains and demonstrating the capacity to inhibit progressive structural damage of joints. However, not all patients responded to these agents and many patients displayed initial response which waned over time, partly due to immunogenicity (development of antibodies which blocked full therapeutic effect of the biologic protein), or because of poor tolerability and/or adverse events. Thus, it has been important to develop new medicines which target other key cytokines and immunologic pathways, including ustekinumab which inhibits both IL12 and IL23 and thus is felt to work in both the TH1 and TH7 pathways of inflammation, has been approved for the treatment of PsA as well as psoriasis. IL17 inhibitors, including secukinumab and ixekizumab have demonstrated significant effectiveness in psoriasis and PsA

Clin Exp Rheumatol. 2013. Is reduction or discontinuation of therapy an acceptable possibility in psoriatic arthritis? Remission in psoriatic arthritis (PsA), albeit variably defined, is a desirable and achievable state, especially in the era of biologic therapy. Historically, studies have used remission criteria derived from rheumatoid arthritis (RA), which indicate that remission is seen in a greater percentage of patients than in RA, including the possibility of drug-free remission in some patients. The Minimal Disease Activity (MDA) measure developed by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is a currently acceptable goal of therapy, taking into account PsA-specific elements such as skin disease and enthesitis. Newer PsA composite measures which include thresholds for remission are under development and are now included in prospective clinical trials. Once remission is achieved and sustained on therapy, a natural question is whether treatment can be reduced or discontinued to avoid treatment toxicities and costs. Exploratory data are being analysed from observational cohorts regarding the capacity to reduce treatment dose, dose frequency, or discontinue use of a medication whilst maintaining remission. A controlled dose-reduction and discontinuation study design is outlined, which may provide controlled evidence for such a paradigm of treatment.

Associated medical conditions
A significantly higher prevalence of thyroid autoimmunity (positive AbTPO, hyoechoic thyroid) findings in men and women with psoriatic arthritis and of subclinical hypothyroidism in women with psoriatic arthritis than in the general population. Therefore, thyroid function tests, an AbTPO assay, and thyroid ultrasound should be considered as part of the clinical evaluation, particularly in women with psoriatic arthritis.
   Overall, people who suffer from psoriatic arthritis do not have a higher risk of cancer compared to the general population. Patients with psoriatic arthritis have an increased risk of cardiovascular disease. Severe inflammation is a risk factor for the development of cardiovascular disease. This is similar to what has been shown for other inflammatory forms of arthritis such as rheumatoid arthritis.

A 2015 research team led by the University of Manchester in England has discovered genetic changes that are linked to PsA but not with psoriasis, making it possible to distinguish between which people with psoriasis are at risk of psoriatic arthritis and which are not.

Nail psoriasis
This is common in adult patients with psoriasis. Traditional treatment includes topical applications of corticosteroids, calcipotriol, retinoids, and 5-fluorouracil, but these treatments don't work too well. Systemic treatments include ciclosporin, methotrexate and acitretin, all of which have a serious toxicity. Early research suggests that psoriatic nail disease may improve with fumaric acid esters.

Questions
I am a doctor from the UK, and have psoriatic arthritis. I have tried a number of complementary therapies to try and overcome a hot, swollen knee including high dose fish oil, boswellia, curcumin, MSM, GLA, and Ginger, with little effect. Nothing seems to work as well as the NSAIDs. I was wondering if you could suggest anything else that may be worth trying.
   We have come across little research regarding the natural treatment for psoriatic arthritis. If you come across something, let us know and we will tell our readers. Perhaps eating a lot of fish, fresh vegetables and fruits, and reducing sugar, white bread, milk, and junk food could be helpful. Using more fish oil, salmon egg, seal oil, etc should be considered. It may be cautious to reduce the dose of the NSAIDs while using high doses of fish oil products.

My sister is suffering from psoriatic arthritis for the last 3 to 4 years and there is a treatment from Hosmat Hospital in Bangalore which cured her skin problem. But the pain in her joints of her feet fingers are still growing and it is getting worse day by day. Do you have a treatment for this which can cure this psoriatic arthritis decease. Please revert us if you need any further information on the symptoms or the treatments availability.
   At this time I don't have any knowledge of a natural treatment for psoriatic arthritis.

I am a 40 yr old male, wt: 150 lbs, ethnicity: Indian. I have suffered from psoriatic arthritis for almost 20 yrs. I have been on multiple NSAIDS. I was most recently on methotrexate po, and enbrel sq. Currently I am ONLY on methotrexate sq as I developed some side effects on enbrel. I am also taking a statin, a baby aspirin, flecainide (h/o lone AFib). I have added curcumin, sam-e, Co-Q10, omega 3 fish oil in the past year. I have read there can be interactions between curcumin and statins, arthritis meds and NSAIDs. I feel very disappointed as I was hoping to use nutraceuticals to actually help protect my liver and boost antioxidant protection as well as joint support. Would you advise I stop all the supplements for now. Of course as a physician I completely understand your information is limited by the lack of a complete history from me and as such you cannot take responsibility for the advice you dispense and the potential outcomes or side effects of what you tell me. I am just seeking some general guidance.

Testimonial
I was afflicted with psoriatic arthritis 18 years ago ( it was severe enough to put an active athlete into the bed!) and went through the routine with clinoril, cyclosporine, quinine based drugs, and then finally methotrexate and humira. The methotrexate was great at the onset, almost 2 years, it made me feel the best of all treatments. It was oral at first but then went to shots as the effectiveness wore off. It got to the point that I had to find that next step. It was humira and I did that for 7 months. It worked OK, but I was constantly sick with colds, flu, allergies, etc. I decided to stop the humira and over time developed my own cocktail which as of today ( almost 2 years, knock on wood) allows me to get around. Iím not supple like I was 18 years ago but I can curl 60# 3x times a day, do 20-30 situps and walk 3 miles religiously. Iíll be 60 next week. There was no science in my decision; I had to go cold turkey with the humira though. Hope this data can help someone else. I realize this alternative stuff doesnít have the same effect for everyone, and it could just be that the 7 months on Humira affected my immune system to the point where I donít need it anymore, at least for the past 20+ months. Daily regiment:∑ 1,500mg krill oil, one 1000, high in the morning and 500 in the evening. I was using a high grade Omega 3 in the beginning but went to Krill in the past 6 months.∑ 1 Aleve in the morning∑ 1 500mg propionyl carnitine in the morning. If I miss a couple days of this regimen, I can feel it when I wake up so something good is happening.

I have been dealing with psoriatic arthritis for about 30 years now. It has done some damage to distal joints as it was only properly diagnosed about 5-6 years ago. I have used methotrexate pill and injection, other non-steroidal anti inflamatories but to no avail. Presently, I am using turmeric and boswellia. I do not believe the boswellia is doing much, however, the turmeric has been excellent in cleaning up my nails. I have actually started trimming them normally for the first time recently. My doctor prescribed some new meds recently which made me very ill. I have stopped coffee and black tea. Just drink green tea. Still having problems with swollen joints, stiffness and much pain.