Integrative Approaches to Care

Physical therapy and rehabilitation are used to maximize the function of an arthritic joint. Rehabilitation interventions frequently involve general aerobic conditioning to help maintain cardiovascular fitness, proper positioning of joints to assist with mobility and coping strategies to help individuals continue or return to work and activities of daily life.

Acupuncture, which has its roots in ancient China, involves the insertion of fine needles along key meridians. The World Health Organization states that acupuncture is useful as adjunct therapy in more than 50 disorders, including low back pain, headaches and nausea. Though no clinical studies directly support its use with psoriasis or psoriatic arthritis, some patients have reported success. A large scale review published in the September 2012 Archives of Internal Medicine shows positive results when using acupuncture to treat chronic pain conditions. Should you decide to try acupuncture (or acupressure, also from China) it is important to visit a licensed acupuncturist. The National Certification Commission for Acupuncture and Oriental Medicine can help you find a professional in your area.

Massage involves the manipulation of superficial layers of muscle and connective tissue to enhance function, improve lymph circulation and promote relaxation. During a massage, the licensed massage therapist may use a variety of techniques to loosen and stretch muscles and joints. Massage can be beneficial for those with psoriasis and psoriatic arthritis. An experienced massage therapist can modify any massage session to meet your comfort level.

Tips for visiting a massage therapist:

• Tell the massage therapist about your psoriasis when you make the appointment. If they do not understand psoriasis, either explain that it’s not contagious or contact a more experienced practitioner.
• Ask what essential oils and lotions they use. Some may be irritating to your skin. If you have lotions you prefer, bring them with you to use during your visit.
• If they are a new practitioner to you, you may want to bring materials such as those from NPF to your appointment to help you explain psoriasis.

According to some research, aloe vera has been shown to help reduce redness and scaling associated with psoriasis. Look for creams containing 0.5 percent aloe. The aloe plant gel can be applied to the skin up to three times a day.

Apple cider vinegar can be used to help relieve scalp itch from psoriasis. Stick with organic apple cider vinegar (which can be found at most grocery stores) and apply it to your scalp several times a week. Diluting the vinegar with water in a one-to-one ratio can help if you experience any burning sensation. Further, rinsing the skin once the solution has dried can help prevent irritation. Avoid using vinegar if you have open wounds, or if your skin is cracked or bleeding.

Capsaicin is the ingredient in chili peppers that makes them spicy. When added to creams and ointments, capsaicin can block nerve endings that transmit pain. Capsaicin may also help to reduce inflammation, redness and scaling associated with psoriasis. However, more research is needed to assess its long-term benefits and safety. Some people may feel a burning sensation where capsaicin ointment is applied.

One possible remedy for removing scales and easing itching associated with psoriasis is to add Dead Sea or Epsom salts to your warm (not hot) bath water and soaking in it for about 15 minutes. To avoid dry skin, apply moisturizer after bathing.

While there is no scientific evidence to support the use of oats to relieve symptoms associated with psoriasis, some individuals have reported a reduction in itch and redness when an oat paste or bath is applied to the skin

Tea tree oil, native to Australia, is believed to have antiseptic qualities and can be applied to the skin. Some people find that using shampoos with tea tree oil helps relieve their scalp psoriasis. However, there are no scientific studies to prove the effectiveness of tea tree oil on psoriasis. Use tea tree oil with care as some people are allergic to it.

Turmeric has been frequently studied for its powerful anti-inflammatory and antioxidant properties. Curcumin, the active ingredient in turmeric, can alter gene expression. Research has identified turmeric’s ability to alter TNF cytokine expression, which can help in minimizing psoriasis and psoriatic arthritis flares for some. You can take turmeric concentrated in pill or supplement form. It is also a main ingredient in many foods, including curries.

Mahonia is a powerful antimicrobial herb that plays a role in immune response. Applying a cream containing 10 percent mahonia is effective in treating mild-to-moderate psoriasis. Because it is in the alkaloid family, mahonia should only be used as a topical unless under physician supervision.

Homeopathy is an alternative medical system. It takes a different approach from conventional medicine in diagnosing, classifying, and treating medical problems. Key concepts of homeopathy include:

• Homeopathy seeks to stimulate the body’s defense mechanisms and processes so as to prevent or treat illness.
• Treatment involves giving very small doses of substances (called remedies) that, according to homeopathy, would produce the same or similar symptoms of illness in healthy people if they were given in larger doses.
• Treatment in homeopathy is tailored to each person. Homeopathic practitioners select remedies according to a total picture of the patient, including not only symptoms but lifestyle, emotional and mental states, and other factors.

Most homeopathies in the United States are practiced along with another health care practice for which the practitioner is licensed, such as conventional medicine, naturopathy, chiropractic, dentistry, or acupuncture.

People report success with homeopathic treatments for psoriasis, including sulfur and nickel. Homeopathic remedies are usually so diluted that they will not cause major side effects. A consultation with someone trained in this practice will help guide the treatment and ensure your safety.

Naturopathy, also called naturopathic medicine, focuses on supporting health rather than combating disease. The practice of naturopathy is based on six key principles:

1. First, do no harm. Naturopathic practitioners choose therapies with the intent to keep harmful side effects to a minimum and not suppress symptoms.
2. Promote the healing power of nature.
3. Treat the whole person. Practitioners believe a person’s health is affected by many factors, such as physical, mental, emotional, genetic, environmental, and social ones. Practitioners consider all these factors when choosing therapies and tailor treatment to each patient.
4. Treat the cause. Practitioners seek to identify and treat the causes of a disease or condition, rather than its symptoms. They believe that symptoms are signs that the body is trying to fight disease, adapt to it, or recover from it.
5. Prevention is the best cure. Practitioners teach ways of living that they consider most healthy and most likely to prevent illness.
6. The physician is a teacher. Practitioners consider it important to educate their patients in taking responsibility for their own health.

Traditional Chinese Medicine (TCM) is a whole medical system that originated in China. It is based on the concept that disease results from disruption in the flow of qi, vital energy, and imbalance in the forces of yin and yang. Practices such as herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi.

In the treatment of psoriasis, oral and topical herbal treatments are used. Psoriasis patients have used the following herbal topicals with some success: aloe, apple cider vinegar, capsaicin (a natural ingredient found in cayenne peppers), emu oil, evening primrose oil, oats, and tea tree oil.

Use caution with all herbals: Some make the skin more sensitive to ultraviolet light, while others may interact with other prescriptions or medications.

Ayurvedic medicine (also called Ayurveda) is one of the world’s oldest medical systems. It originated in India and has evolved there over thousands of years. It aims to integrate and balance the body, mind, and spirit; thus, some view it as holistic, treating the body as a whole and not just the symptoms of an illness.

The aim of Ayurvedic medicine is to integrate and balance the body, mind and spirit. This is believed to help prevent illness and promote wellness. Ayurvedic medicine uses a variety of products and techniques to cleanse the body and restore balance. Some of these products may be harmful if used improperly or without the direction of a trained practitioner. For example, some herbs can cause side effects or interact with conventional medicines.

A practice from Ayurvedic medicine that combines breathing exercises, physical postures, and meditation. It is intended to calm the nervous system and balance the body, mind and spirit. There are various styles of yoga that people use for health purposes. They typically combine physical postures, breathing techniques, and meditation or relaxation. There are numerous schools of yoga. Hatha yoga, the most commonly practiced in the U.S. and Europe, emphasizes postures and breathing exercises. People use yoga for a variety of conditions and to achieve fitness and relaxation. Yoga has also been used in traditional Chinese medicine and is also considered a mind-body medicine technique.

Yoga can help bring stress under control. Some people with psoriatic arthritis anecdotally report that yoga can help ease pain and improve range of motion.

Surgery can help people whose joint destruction limits motion and function despite medical treatment.

Various dietary supplements have been reported to help some people with arthritis. Some of these include vitamin D, fish oil, glucosamine, chondroitin, methylsulfonylmethane (MSM) and S-adenosylmethionine (SAM-e).

Exercise is essential to preserve strength and maintain range of motion. Isometric exercise is often prescribed because it appears to be less damaging to inflamed joints. A range-of-motion program should be coupled with a stretching program.

Pain lasting for two hours after exercise is a sign of overdoing it or of choosing the wrong exercise. Stretching exercises are part of the treatment, and are especially useful for spinal arthritis.

In addition to exercise and local pain therapy, a splint may be used to support a joint in a position to improve function and relieve pain and swelling.

Foot and ankle arthritis is common in psoriatic arthritis. It can cause a great deal of pain. “Sausage” toes are swollen, painful and do not fit into standard shoes. A shoe with a high toe box or an extra-depth shoe can provide relief. Shoe inserts, heel cups and/or pads also may be used in shoes to relieve pain from heel spurs and arthritis in other areas of the foot. A podiatrist, a doctor who specializes in the feet, may be able to provide additional help for people with psoriatic arthritis of the feet and ankles.

Heat, cold and rest are used to relieve pain. Immobilizing an inflamed swollen area while using cold packs can reduce the swelling and improve range of motion. Follow your health care provider's directions.

Osteoporosis, the progressive deterioration of bone density, may occur with arthritis — especially with psoriatic spondylitis (inflammation of the spine) — and fractures from minor trauma may occur. Prolonged use of corticosteroids and inactivity can potentially induce osteoporosis. Calcium supplements along with vitamin D help prevent it in affected individuals. In addition, calcitonin and biphosphonates (prescription drugs that affect calcium metabolism and bone formation) may be used. Avoid prolonged bed rest unless directed by a health care provider.