Psoriasis and Psoriatic Arthritis
Psoriasis and psoriatic arthritis are related chronic inflammatory autoimmune conditions but differ in the tissue affected. In psoriasis, the inflammation is directed toward the skin. In psoriatic arthritis, the inflammation is directed toward the joints, similar to rheumatoid arthritis, causing inflammation (swelling, redness, pain and stiffness) and damage. Like any autoimmune condition, psoriasis and psoriatic arthritis can manifest from mild to severe disease. There is a relationship between the severity of skin disease and arthritic involvement but they do not always correlate. Some patients may have severe skin disease and no arthritis and some arthritis patients may have only minimal skin disease.
Psoriasis causes cells to build up rapidly on the surface of the skin, forming thick, silvery scales and itchy, dry, red patches that are sometimes painful. It can also affect the nails, leading to thickened, pitted or ridged nails or the joints, leading to swollen and stiff joints. This condition is known as psoriatic arthritis.
Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.
The cause of psoriasis isn’t clear, but it’s thought to involve an immune system dysfunction involving immune cells (lymphocytes) called T cells. In psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.
Researchers have found genes that are linked to the development of psoriasis, but as in most autoimmune conditions, environmental factors probably play a larger role. There are a number of environmental factors that may trigger psoriasis including:
- Infections, such as strep throat or skin infections
- Injury to the skin, such as a cut or scrape, bug bite, or a severe sunburn
- Cold weather
- Heavy alcohol consumption
- Certain medications — including lithium, which is prescribed for bipolar disorder, high blood pressure medications such as beta blockers, antimalarial drugs and iodides.
Psoriatic arthritis is a chronic inflammatory arthritis affecting the joints that typically occurs in people with skin psoriasis, but it can occur in people without skin psoriasis, particularly in those who have relatives with psoriasis. In some people, it is mild, with just occasional flare ups. In other people, it is continuous and can cause joint damage if it is not treated.
Psoriatic arthritis typically affects the large joints, especially those of the lower extremities, distal joints of the fingers and toes, and also can affect the back and sacroiliac joints of the pelvis. Although the disease usually isn’t as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that can lead to permanent deformity. Psoriatic arthritis is sometimes misdiagnosed as gout, rheumatoid arthritis or osteoarthritis.
Conventional Treatment of Psoriasis and Psoriatic Arthritis
The primary goal of treatment for psoriasis is to stop the skin cells from growing so quickly. While there isn’t a cure, psoriasis treatments may offer significant relief.
Treatment for psoriatic arthritis includes various types of immune-suppressing medications including NSAIDs, corticosteroids, DMARDs and biologics.
Psoriasis treatments can be divided into three main types: topical treatments, light therapy and systemic medications.
- Topical treatments. Topical creams and ointments that you apply to your skin can effectively treat mild to moderate psoriasis. These include topical immune-suppressing medications such as corticosteroids. These medications slow cell turnover by suppressing the immune system, which reduces inflammation and relieves associated itching.
- Light therapy (phototherapy). This treatment uses natural or artificial ultraviolet light. This includes exposing your skin to controlled amounts of natural sunlight or other forms of light therapy, including the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light either alone or in combination with medications.
- Oral or injected medications. For severe psoriasis or psoriatic arthritis, oral or injected drugs are usually used. These include stronger immune-suppressing medications such as methotrexate, cyclosporine, DMARDs (disease-modifying antirheumatic drugs) and a newer class of medications known as biologics. These drugs can decrease the symptoms of flare-ups and slow the progression of psoriasis or psoriatic arthritis by decreasing the rate of damage to organs and other tissues from the inflammation that occurs but they do this by suppressing the immune system. Side effects of DMARDs vary but may include fatigue, liver damage, bone marrow suppression and severe lung infections. Side effects of biologics include risk of serious infection and various allergic reactions.
Functional Medicine Management of Psoriasis and Psoriatic Arthritis
A comprehensive approach to the management of complex conditions such as autoimmune disease must take into consideration many aspects of health, including gut barrier integrity and imbalances of gut flora, liver detoxification capacity and toxic burden, hormone imbalances, energy production capacity, nutrient status and most importantly, immune imbalances which promote autoimmune states. More specifically, Functional Medicine approaches autoimmune disease by identifying the triggers and mediators of the autoimmune attacks, minimizing the self-destructive immune responses and enhancing the body’s ability to recover from flare-ups.
There are 4 areas of management of autoimmune conditions in the Functional Medicine approach:
- Identifying and avoiding the triggers of autoimmune responses
- Modulating the autoimmunity and reducing tissue destruction
- Enhancing and supporting recovery from flare-ups
- Addressing associated conditions that promote autoimmune responses
Identifying and avoiding the triggers of autoimmune responses
Lab testing is a critical first step in identifying the extent of systemic inflammation and ruling out many environmental insults which act as triggers and mediators of autoimmunity, such as chronic infection, heavy metal toxicity and decreased capacity to perform liver detoxification.
Food sensitivities can also promote inflammation and potentially drive autoimmune responses.
Identifying and addressing these issues is critical in autoimmune patients to minimize damage and promote restorative function.
Modulating the autoimmunity and reducing tissue destruction
Functional Medicine addresses diet and lifestyle issues as well as using anti-inflammatory and immune-modulating herbs and nutritional compounds to decrease immune responses to self-tissue.
Identifying the triggers of autoimmunity and modulating the immune response can have powerful long-term positive effects on slowing or stopping tissue destruction and improving quality of life.
Enhancing and supporting recovery from flare-ups
There are a number of natural compounds that help support a faster recovery by breaking down offending triggers, increasing blood flow to target tissue, and dampening the immune response.
Addressing associated conditions that promote autoimmune responses
Intestinal permeability promotes autoimmunity
There is growing evidence that increased intestinal permeability plays a pathogenic role in various autoimmune diseases. Increased intestinal permeability and compromised gut integrity appears to precede AI disease and predisposes to immune activation and chronic inflammation. Assessment and proper restoration of the integrity of the intestinal barrier is crucial in managing autoimmune conditions.
The following nutritional interventions are usually used:
Anti-inflammatory and immune-modulating compounds
Anti-inflammatory and immune-modulating herbs and nutritional compounds to decrease excessive immune responses can very often be helpful.
Nutrients to regenerate the epithelial lining
There are various plant compounds, vitamins and minerals that have been shown to have a restorative effect on a damaged intestinal barrier and a proper selection and regime can be very effective.
Nutrients to decrease food sensitivities
Food sensitivities are very common in people with autoimmune disease. Compounds that have been shown to decrease specific immune responses in the gut related to food sensitivity can be helpful.
There is growing evidence that increased intestinal permeability plays a pathogenic role in various autoimmune diseases. Identifying the existence of intestinal permeability and addressing this condition, leads to a more comprehensive and satisfactory outcome in the autoimmune patient.