Psoriatic Arthritis Treatment With Herbs and Diet
A Holistic Approach
Psoriasis and Psoriatic Arthritis
Psoriasis is a chronic inflammatory condition that manifests in the skin. The naturopathic approach always includes eliminating the obstacles to health, and this is especially important in the case of psoriasis. Identifying and eliminating triggers of the disease can be challenging, but when stress and other major triggers are effectively reduced, remission is possible. One postulated trigger could be described as bowel toxemia. Incomplete protein digestion, food allergies, increased intestinal permeability, and a stressed liver all have been speculated as factors that increase the propensity towards inflammatory skin conditions such as psoriasis.[1-3,18]
Psoriatic arthritis (PsA) is a comorbidity of psoriasis, manifesting as inflammation of the joints. Inflammatory mediators cause damage to cartilage and bone in the joints, leading to remodeling distinct from other joint pathologies such as rheumatoid arthritis. Risk factors for developing PsA in patients with an existing diagnosis of psoriasis include obesity, family history, injury, trauma, and smoking. Similar to psoriasis, certain theories about the impact of intestinal permeability, altered immune homeostasis, and imbalance of short- and medium-chain fatty acid-producing bacteria exist to explain the role of the microbiome on the development of PsA.
A major nutritional recommendation for patients with psoriasis or PsA includes a higher intake of omega-3 fatty acids.[16,17] Fatty fish and flax which contain omega-3 fatty acids have shown to reduce system inflammation. Patients with Psoriasis and PsA are at a higher risk of developing other autoimmune diseases, including a two-fold increase in celiac disease. These patients can have serologic markers of gluten sensitivity without duodenal biopsy results to indicate true celiac disease. Studies have also shown that patients with higher celiac disease-specific antibody levels exhibit higher psoriasis disease severity. It’s no wonder that in several studies, psoriasis or PsA patients have shown improvement after adopting a gluten-free diet.[1,2,22] Other powerful dietary interventions such as low-calorie diets that induce a state of ketosis, where the body shifts its source of energy from glucose rich stores called glycogen, to fat stored in adipose tissue. This state of metabolism can be achieved from fasting, or a low-calorie vegetarian diet. Long-term weight reduction and controlled meal frequency without caloric restrictions have also shown to have immune modulating effects reducing skin diseases such as psoriasis and PsA.[4-7,22] Available literature also demonstrates an improvement in psoriasis symptoms alongside dietary supplementation with vitamin D, vitamin B12, and selenium.[17,22]
For more challenging cases of psoriasis or PsA, herbal intervention may be warranted. Silybum marianum, commonly known as Milk Thistle, is a well known herb used in the treatment of inflammatory mediated disease. There is a proposed correlation between fatty liver disease and psoriasis. The liver is also a well-known source of internal antioxidants required for the balance of inflammation in the body. An active component of Psoralea coryliforia, 8-methoxypsoralen, is often combined with ultraviolet light therapy for the treatment of psoriasis, called psoralen plus ultraviolet A or PUVA. Psorelan can be administered one of three ways; as oral psoralen, topical psoralen application or by psoralen-bath. Psoralen-bath therapy has been shown in studies to reduce the severity of psoriasis.[10,11] This therapeutic entails the patient bathing in a 8-methopsoralen dilution for 15 minutes and then being exposed to UVB radiation, as opposed to taking the psoralen orally and then undergoing phototherapy. Total glucoside of peony (TGP), extracted from the dried roots of Paeonia lactiflora, is a biologically active compound previously shown to have anti-inflammatory effects. Wang et al. demonstrated a reduction in PsA disease activity after treatment with oral TGP in 32% of patients who received the intervention. Curcumin or turmeric, the bioactive component of the plant Curcuma longa, has shown to have anti-inflammatory action by modulating the levels of pro-inflammatory cytokines. In one study, peripheral blood mononuclear cells were isolated from 34 patients with psoriasis or PsA and were then pretreated with curcumin. Cells stimulated with pharmacologic concentrations of curcumin showed a decrease in IFN-y and IL-17 pro-inflammatory cytokine production.
Alternatives is a botanical category that includes herbs traditionally used to improve the quality of the blood, promote healthy digestion, and increase the body’s rate of elimination. Mahonia aquifolium, better known as Oregon grape, has shown in studies to inhibit the cell growth of human skin cells, the pathophysiology seen at the skin level of psoriatic lesions. Additionally, Oregon grape has demonstrated antioxidant propertiesas been postulated as one mechanism of therapeutic benefits seen in M. aquifolium extracts.
Special care should be taken when choosing any herbal treatment or adhering to any new dietary change. It is imperative to have medical guidance when implementing any regimen that might have adverse side effects. Please refrain from calorie restricted diets and herbal supplementation until consulting a medical professional.
- Araujo ML, Burgos MG, Moura IS. [Nutritional influences in psoriasis]. An Bras Dermatol.2009;84(1):90-92; PMID: 19377768 https://www.ncbi.nlm.nih.gov/pubmed/19377768.
- Brown AC, Hairfield M, Richards DG, et al. Medical nutrition therapy as a potential complementary treatment for psoriasis--five case reports. Altern Med Rev.2004;9(3):297-307; PMID: 15387720 https://www.ncbi.nlm.nih.gov/pubmed/15387720.
- Lithell H, Bruce A, Gustafsson IB, et al. A fasting and vegetarian diet treatment trial on chronic inflammatory disorders. Acta Derm Venereol.1983;63(5):397-403; PMID: 6197838 https://www.ncbi.nlm.nih.gov/pubmed/6197838.
- Dixit VD, Yang H, Sayeed KS, et al. Controlled meal frequency without caloric restriction alters peripheral blood mononuclear cell cytokine production. J Inflamm (Lond).2011;8:6; PMID: 21385360 https://www.ncbi.nlm.nih.gov/pubmed/21385360.
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- Jensen P, Christensen R, Zachariae C, et al. Long-term effects of weight reduction on the severity of psoriasis in a cohort derived from a randomized trial: a prospective observational follow-up study. Am J Clin Nutr.2016;104(2):259-265; PMID: 27334236 https://www.ncbi.nlm.nih.gov/pubmed/27334236.
- Castaldo G, Galdo G, Rotondi Aufiero F, et al. Very low-calorie ketogenic diet may allow restoring response to systemic therapy in relapsing plaque psoriasis. Obes Res Clin Pract.2016;10(3):348-352; PMID: 26559897 https://www.ncbi.nlm.nih.gov/pubmed/26559897.
- Surai PF. Silymarin as a Natural Antioxidant: An Overview of the Current Evidence and Perspectives. Antioxidants (Basel).2015;4(1):204-247; PMID: 26785346 https://www.ncbi.nlm.nih.gov/pubmed/26785346.
- Gisondi P, Del Giglio M, Cozzi A, et al. Psoriasis, the liver, and the gastrointestinal tract. Dermatol Ther.2010;23(2):155-159; PMID: 20415823 https://www.ncbi.nlm.nih.gov/pubmed/20415823.
- Furuhashi T, Saito C, Torii K, et al. Photo(chemo)therapy reduces circulating Th17 cells and restores circulating regulatory T cells in psoriasis. PLoS One.2013;8(1):e54895; PMID: 23365685 https://www.ncbi.nlm.nih.gov/pubmed/23365685.
- Kubo R, Muramatsu S, Sagawa Y, et al. Bath-PUVA therapy improves impaired resting regulatory T cells and increases activated regulatory T cells in psoriasis. J Dermatol Sci.2017;86(1):46-53; PMID: 28139335 https://www.ncbi.nlm.nih.gov/pubmed/28139335.
- Muller K, Ziereis K, Gawlik I. The antipsoriatic Mahonia aquifolium and its active constituents; II. Antiproliferative activity against cell growth of human keratinocytes. Planta Med.1995;61(1):74-75; PMID: 7700998 https://www.ncbi.nlm.nih.gov/pubmed/7700998.
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