Tim Petrie, DPT, OCS, is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade.
Leah Ansell, MD, is board-certified in cosmetic and medical dermatology. She is an assistant professor at Columbia University and works in private practice in New York City.
Psoriatic arthritis (PsA) is a chronic inflammatory condition that causes the body’s immune system to attack its own tissue. This autoimmune disease, which is frequently seen alongside the skin condition psoriasis, causes inflammation, swelling, and pain in the body’s joints.
Because of the lifelong nature of this disease and the challenges in addressing its symptoms, there has been a renewed interest in using complementary and alternative medicine (CAM) to supplement more conventional treatments.
This article will discuss the CAM options that are available for PsA and their relative effectiveness.
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Before considering the treatment options that are available, it is important to properly define CAM therapy.
According to the National Center for Complementary and Integrative Health, CAM therapies consist of any healthcare treatments or medical practices that are not currently associated with conventional medicine.
These CAM options can be categorized as complementary, meaning they are designed to work alongside traditional treatments, or alternative, meaning they are meant to take the place of more mainstream options. They can also be further divided into two subsets:
Understanding the purpose of each CAM option and its potential advantages can help you decide if it is right for you.
Up to 51% of people with PsA report that they have used a CAM treatment. This high number may reflect the overall dissatisfaction with the effectiveness of traditional treatments or the relatively common adverse side effects associated with PsA medications.
Before trying CAM therapies, it is important to have an understanding of the benefits that may be gained from them. The potential advantages of holistic treatments include:
There are a wide variety of complementary and alternative treatments that claim to improve the symptoms of psoriatic arthritis. While many of these claims remain unproven or dubious, there are some worthwhile CAM options.
Over-the-counter nutritional supplements are commonly touted as a natural treatment for PsA. While many are ineffective (and potentially harmful), some may have value when used as a complementary treatment.
One study found that a six-month vitamin D3 regimen led to fewer tender joints and lower inflammation levels. Another research paper discovered individuals who took D3 had lower levels of disease activity after six months than people with psoriatic arthritis who did not use the supplement.
Polyunsaturated fatty acid supplements have also shown promise. One smaller research study showed that people with PsA who took the substance reported lower amounts of pain and reduced disability after eight weeks. Another article concluded that taking oral seal oil, a type of polyunsaturated fatty acid, led to a decrease in the number of swollen and tender arthritic joints.
Even with these purported benefits, however, it is important to note that these studies were all
relatively small and of questionable quality. Because of this, the value of these supplements is still unclear.
To this point, the research investigating the use of acupuncture to treat PsA is largely limited to case studies and low-quality experiments. That said, there is some evidence to suggest that the treatment may be beneficial.
For example, the authors of one study found that 52% of people with long-standing PsA who had responded poorly to traditional medications had either moderate or complete resolution of their pain after acupuncture. Other case studies have also found similar improvements in pain as well as reductions in disease severity and medication reliance. More high-quality evidence is needed on this CAM, though it is recommended conditionally as a treatment for psoriatic arthritis by the National Psoriasis Foundation.
While it may seem surprising, performing meditation exercises may be an effective way to help your psoriatic arthritis symptoms. This may be because increased stress levels are a potential trigger of a psoriatic flare-up.
One study found that individuals who listened to a guided meditation recording while undergoing ultraviolet light treatments for their psoriasis experienced clearer skin more quickly than those who had the light treatments alone. Another examined the effects of using guided imagery and meditation in people with psoriasis and found a small yet significant improvement in the severity of their disease after seven sessions.
The majority of research on mediation for psoriasis has shown positive benefits for the skin-related symptoms of the disease. That said, PsA flare-ups are also correlated with stress. Because of this, meditation may be a worthwhile and low-risk adjunct to more conservative treatments.
Several herbal treatments may be helpful for PsA, though the research supporting them is still extremely limited. Very small studies have shown reduced inflammatory markers in patients with psoriatic arthritis who were treated with traditional Chinese herbs like thunder god vine or paeony extracts.
The use of curcumin (also known as turmeric) has also been shown to have anti-inflammatory effects. One review deemed the herb’s pain-relieving potential to be similar to the effects of taking NSAID medications.
Finally, early case studies have found some improvement in pain and swelling levels in PsA patients who use topical cannabis or CBD preparations. The research in this area is still very preliminary and inconclusive, however.
Modifying your diet can help address the symptoms of PsA. Eating a well-balanced diet that is full of fruits, vegetables, and lean proteins can help you maintain a healthy body weight. This in turn reduces the amount of strain placed on your arthritic joints. Losing any excess weight can also help you stay more active, which in turn helps alleviate joint soreness and stiffness.
In addition, carrying excess body fat has been linked to increased levels of inflammation in the body. By altering your food intake and avoiding fried or sugary items, you can reduce the likelihood that your joints become swollen and inflamed.
Massage therapy is sometimes suggested as a possible CAM treatment for psoriatic arthritis. Unfortunately, there is minimal research to date that shows that this hands-on technique is effective in addressing PsA symptoms. That said, there are several studies that have shown that is effective in relieving pain in people with both osteoarthritis and rheumatoid arthritis. Because of this, the National Psoriasis Foundation does conditionally recommend the use of massage for people with psoriatic arthritis.
While many of the CAM treatments detailed above have shown promise in addressing the symptoms of PsA, most of the findings are still very preliminary. Because of this, it is important to continue taking your conventional medications for inflammation as they have been prescribed by a healthcare provider.
In addition, some complementary or alternative treatments can have adverse side effects or may negatively interact with medications you are already taking. Speak to your physician about your symptoms before experimenting with CAM therapies for psoriatic arthritis.
Preliminary research has shown that certain CAM therapies may be useful adjuncts when treating psoriatic arthritis. Certain herbal treatments or dietary supplements may be helpful in reducing joint inflammation or soreness. Other dietary modifications and meditation practices may help improve your mobility and decrease the duration of flare-ups. It is important to speak to a healthcare provider before trying holistic options to ensure they are appropriate for your situation.
Dealing with psoriatic arthritis can be a frustrating experience. The condition’s symptoms are often unpredictable and they can significantly limit your ability to go about your day. Fortunately, the research on several CAM therapies has shown promising benefits. While not meant to replace traditional treatments, it is worth discussing whether these options can be used to complement more conventional medications with your physician.
The best way to find reputable CAM practitioners is by searching for them through professional organizations. The American Society of Acupuncturists lets you look for accredited practitioners. Licensed massage therapists can also be located on the American Massage Therapy Association’s website.
Certain dietary supplements like vitamin D3 or polyunsaturated fatty acids may help reduce inflammation levels in the body. Other herbal treatments like curcumin or topical CBD may also be useful. On the whole, these CAM therapies should be viewed only as a potential adjunct and not as an alternative to methotrexate.
Coverage of CAM therapies like acupuncture or massage varies based on the policy. In many cases, a health savings or flexible spending account may be used to pay for the service if it is recommended by a physician. Be sure to speak to your insurance carrier if you have specific questions about CAM coverage.
Gamret AC, Price A, Fertig RM,Lev-Tov H, Nichols AJ. Complementary and alternative medicine therapies for psoriasis: a systematic review. JAMA Dermatol.2018;154(11):1330. doi:10.1001/jamadermatol.2018.2972
Roberts JA, Mandl LA. Complementary and alternative medicine use in psoriatic arthritis patients: a review. Curr Rheumatol Rep.2020;22(11):81. doi:10.1007/s11926-020-00956-x
Arthritis Foundation. Healthylifestyle habits when you have PsA.
Tim Petrie, DPT, OCS, is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade.
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