Skip to main content

Advertisement

Log in

Complementary and Alternative Medicine Use in Psoriatic Arthritis Patients: a Review

  • Complementary and Alternative Medicine (S Kolasinski, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

While complementary and alternative medicine (CAM) use is prevalent in the general population and is known to be used in systemic rheumatic disease such as rheumatoid arthritis and systemic lupus erythematosus, its use in psoriatic arthritis (PsA) is less well-studied. The purpose of this review was to identify published data describing the use of CAM in patients with PsA.

Recent Findings

PsA patients report frequent use of CAM. Diet is believed to affect disease activity, and dietary approaches are used by patients to mitigate symptoms. Dietary supplements have been studied, especially fatty acids, with some positive results. Herbal remedies show promise, but more and better studies are needed, including evaluating medical cannabis. Studies of some the most commonly used CAM, such as acupuncture and massage, are conspicuously absent.

Summary

CAM use is common among patients with PsA. There is, however, a significant knowledge gap, and there is a critical need for rigorous research to ensure safe and effective use of CAM for these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Phang JK, Kwan YH, Goh H, Tan VIC, Thumboo J, Østbye T, et al. Complementary and alternative medicine for rheumatic diseases: a systematic review of randomized controlled trials. Complement Ther Med. 2018;37:143–57. https://doi.org/10.1016/j.ctim.2018.03.003.

    Article  PubMed  Google Scholar 

  2. Roberts J IV, Mandl L, Abutalib Z, Schwartzman S. Use of complementary and alternative medicine (CAM) in a psoriatic arthritis cohort [abstract]. Arthritis Rheumatol. 2019;71(suppl 10).

  3. Krueger G, Koo J, Lebwohl M, Menter A, Stern RS, Rolstad T. The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey. Arch Dermatol. 2001;137:280–4.

    CAS  PubMed  Google Scholar 

  4. Dubertret L, Mrowietz U, Ranki A, van de Kerkhof PCM, Chimenti S, Lotti T, et al. European patient perspectives on the impact of psoriasis: the EUROPSO patient membership survey. Br J Dermatol. 2006;155:729–36. https://doi.org/10.1111/j.1365-2133.2006.07405.x.

    Article  CAS  PubMed  Google Scholar 

  5. Williamson L, Dockerty JL, Dalbeth N. Treatment of psoriatic arthritis. Rheumatology (Oxford). 2004;43:938–9. https://doi.org/10.1093/rheumatology/keh189.

    Article  CAS  Google Scholar 

  6. Tharakan CS, Ungcharoen N, Sabu J, Moorthy A. Complementary and alternative medicine in rheumatology: a survey of its use for common rheumatological conditions among multi-ethnic patients in Leicestershire. Ann Rheum Dis. 2019;78(supplement 2):A621. https://doi.org/10.1136/annrheumdis-2019-eular.6493.

    Article  Google Scholar 

  7. Klingberg E, Wallerstedt SM, Torstenson T, Håwi G, Forsblad-d’Elia H. The use of complementary and alternative medicine in outpatients with inflammatory rheumatic diseases in Sweden. Scand J Rheumatol. 2009;38:472–80. https://doi.org/10.3109/03009740902994280.

    Article  CAS  PubMed  Google Scholar 

  8. Zachariae H, Zachariae R, Blomqvist K, Davidsson S, Molin L, Mørk C, et al. Treatment of psoriasis in the Nordic countries: a questionnaire survey from 5739 members of the psoriasis associations. Data from the Nordic quality of life study. Acta Derm Venereol. 2001;81:116–21. https://doi.org/10.1080/00015550152384254.

    Article  CAS  PubMed  Google Scholar 

  9. Breuer GS, Orbach H, Elkayam O, Berkun Y, Paran D, Mates M, et al. Use of complementary and alternative medicine among patients attending rheumatology clinics in Israel. Isr Med Assoc J. 2006;8:184–7.

    PubMed  Google Scholar 

  10. Fletcher A, Staples M, Hill C, Lassere M, March L, Carroll G, et al. Use of oral complementary medicine in inflammatory arthritis: data from the Australian Rheumatology Association Database (ARAD) [abstract]. Arthritis Rheumatol. 2018;70(suppl 10).

  11. Mok C, Pak C, Wong C, To C, Tse S, Ho L. Use of complementary and alternative medicine (CAM) in Chinese patients with rheumatic diseases: prevalence and associated demographic, clinical and social factors. Ann Rheum Dis. 2015;74(supplement 2):307. https://doi.org/10.1136/annrheumdis-2015-eular.3423.

    Article  Google Scholar 

  12. Lahiri M, Santosa A, Teoh LK, Clayton JA, Lim SY, Teng GG, et al. Use of complementary and alternative medicines is associated with delay to initiation of disease-modifying anti-rheumatic drug therapy in early inflammatory arthritis. Int J Rheum Dis. 2017;20:567–75. https://doi.org/10.1111/1756-185X.13091.

    Article  CAS  PubMed  Google Scholar 

  13. Haugen M, Kjeldsen-Kragh J, Nordvåg BY, Førre O. Diet and disease symptoms in rheumatic diseases--results of a questionnaire based survey. Clin Rheumatol. 1991;10:401–7. https://doi.org/10.1007/bf02206660.

    Article  CAS  PubMed  Google Scholar 

  14. Afifi L, Danesh MJ, Lee KM, Beroukhim K, Farahnik B, Ahn RS, et al. Dietary behaviors in psoriasis: patient-reported outcomes from a U.S. National Survey. Dermatol Ther (Heidelb). 2017;7:227–42. https://doi.org/10.1007/s13555-017-0183-4.

    Article  Google Scholar 

  15. Adawi M, Damiani G, Bragazzi NL, Bridgewood C, Pacifico A, Conic RRZ, et al. The impact of intermittent fasting (Ramadan fasting) on psoriatic arthritis disease activity, enthesitis, and dactylitis: a multicentre study. Nutrients. 2019;11:601. https://doi.org/10.3390/nu11030601.

    Article  CAS  PubMed Central  Google Scholar 

  16. Lithell H, Bruce A, Gustafsson IB, Höglund NJ, Karlström B, Ljunghall K, et al. A fasting and vegetarian diet treatment trial on chronic inflammatory disorders. Acta Derm Venereol. 1983;63:397–403.

    CAS  PubMed  Google Scholar 

  17. Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J, Buil-Cosiales P, Corella D, et al. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One. 2012;7:e43134. https://doi.org/10.1371/journal.pone.0043134.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. • Caso F, Navarini L, Carubbi F, Picchianti-Diamanti A, Chimenti MS, Tasso M, et al. Mediterranean diet and psoriatic arthritis activity: a multicenter cross-sectional study. Rheumatol Int. 2020;40:951–8. https://doi.org/10.1007/s00296-019-04458-7. This study showed that low adherence to Mediterranean diet was associated with higher PsA disease activity.

    Article  PubMed  Google Scholar 

  19. Di Minno MND, Peluso R, Iervolino S, Russolillo A, Lupoli R, Scarpa R, et al. Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor α blockers. Ann Rheum Dis. 2014;73:1157–62. https://doi.org/10.1136/annrheumdis-2012-202812.

    Article  CAS  PubMed  Google Scholar 

  20. Abou-Raya A, Abou-Raya S, Helmii M. Effect of exercise and dietary weight loss on symptoms and systemic inflammation in obese adults with psoriatic arthritis: randomized controlled trial. Ann Rheum Dis. 2014;73:89–90. https://doi.org/10.1136/annrheumdis-2014-eular.2760.

    Article  Google Scholar 

  21. Leite BF, Morimoto MA, Gomes C, Klemz BN, Genaro PS, Shivappa N, et al. Benefits of hipocaloric diet-induced weight loss on psoriatic arthritis disease activity is not improved by fish oil: the DIETA trial. J Psoriasis Psoriatic Arthritis. 2019;4:161–2. https://doi.org/10.1177/2475530319855519.

    Article  Google Scholar 

  22. • Klingberg E, Bilberg A, Björkman S, Hedberg M, Jacobsson L, Forsblad-d’Elia H, et al. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Res Ther. 2019;21:17. https://doi.org/10.1186/s13075-019-1810-5. This study showed that weight loss treatment with very low energy diet was associated with improvements in PsA disease activity, with more weight loss showing larger improvements.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cutolo M, Plebani M, Shoenfeld Y, Adorini L, Tincani A. Vitamin D endocrine system and the immune response in rheumatic diseases. Vitam Horm. 2011;86:327–51. https://doi.org/10.1016/B978-0-12-386960-9.00014-9.

    Article  CAS  PubMed  Google Scholar 

  24. Cubillos S, Krieg N, Norgauer J. Effect of vitamin D on peripheral blood mononuclear cells from patients with psoriasis vulgaris and psoriatic arthritis. PLoS One. 2016;11:e0153094. https://doi.org/10.1371/journal.pone.0153094.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Huckins D, Felson DT, Holick M. Treatment of psoriatic arthritis with oral 1,25-dihydroxyvitamin D3: a pilot study. Arthritis Rheum. 1990;33:1723–7. https://doi.org/10.1002/art.1780331117.

    Article  CAS  PubMed  Google Scholar 

  26. Gaál J, Lakos G, Szodoray P, Kiss J, Horváth I, Horkay E, et al. Immunological and clinical effects of alphacalcidol in patients with psoriatic arthropathy: results of an open, follow-up pilot study. Acta Derm Venereol. 2009;89:140–4. https://doi.org/10.2340/00015555-0555.

    Article  CAS  PubMed  Google Scholar 

  27. Kharaeva Z, Gostova E, De Luca C, Raskovic D, Korkina L. Clinical and biochemical effects of coenzyme Q10, vitamin E, and selenium supplementation to psoriasis patients. Nutrition. 2009;25:295–302. https://doi.org/10.1016/j.nut.2008.08.015.

    Article  CAS  PubMed  Google Scholar 

  28. Lassus A, Dahlgren AL, Halpern MJ, Santalahti J, Happonen HP. Effects of dietary supplementation with polyunsaturated ethyl ester lipids (Angiosan®) in patients with psoriasis and psoriatic arthritis. J Int Med Res. 1990;18:68–73. https://doi.org/10.1177/030006059001800109.

    Article  CAS  PubMed  Google Scholar 

  29. Veale DJ, Torley HI, Richards IM, O’Dowd A, Fitzsimons C, Belch JJ, et al. A double-blind placebo controlled trial of Efamol marine on skin and joint symptoms of psoriatic arthritis. Br J Rheumatol. 1994;33:954–8. https://doi.org/10.1093/rheumatology/33.10.954.

    Article  CAS  PubMed  Google Scholar 

  30. Madland TM, Björkkjaer T, Brunborg LA, Fröyland L, Berstad A, Brun JG. 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 Rheumatol. 2006;33:307–10.

    CAS  PubMed  Google Scholar 

  31. •• Kristensen S, Schmidt EB, Schlemmer A, Rasmussen C, Johansen MB, Christensen JH. Beneficial effect of n-3 polyunsaturated fatty acids on inflammation and analgesic use in psoriatic arthritis: a randomized, double blind, placebo-controlled trial. Scand J Rheumatol. 2018;47:27–36. https://doi.org/10.1080/03009742.2017.1287304. This study showed that n-3 polyunsaturated fatty acid supplementation permitted decreased use of NSAIDs and paracetamol and led to a decrease in leukotriene B4 levels.

    Article  CAS  PubMed  Google Scholar 

  32. Dawczynski C, Hackermeier U, Viehweger M, Stange R, Springer M, Jahreis G. Incorporation of n-3 PUFA and γ-linolenic acid in blood lipids and red blood cell lipids together with their influence on disease activity in patients with chronic inflammatory arthritis - a randomized controlled human intervention trial. Lipids Health Dis. 2011;10:130. https://doi.org/10.1186/1476-511X-10-130.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Cyong J, Otsuka Y. A pharmacological study of the anti-inflammatory activity of Chinese herbs. A review. Acupunct Electrother Res. 1982;7:173–202. https://doi.org/10.3727/036012982816952116.

    Article  CAS  PubMed  Google Scholar 

  34. Ma J, Dey M, Yang H, Poulev A, Pouleva R, Dorn R, et al. Anti-inflammatory and immunosuppressive compounds from Tripterygium wilfordii. Phytochemistry. 2007;68:1172–8. https://doi.org/10.1016/j.phytochem.2007.02.021.

    Article  CAS  PubMed  Google Scholar 

  35. Zhou Y-Z, Zhao L-D, Chen H, Zhang Y, Wang D-F, Huang L-F, et al. Comparison of the impact of Tripterygium wilfordii hook F and methotrexate treatment on radiological progression in active rheumatoid arthritis: 2-year follow up of a randomized, non-blinded, controlled study. Arthritis Res Ther. 2018;20:70. https://doi.org/10.1186/s13075-018-1563-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Xu WY, Zheng JR, Lu XY. Tripterygium in dermatologic therapy. Int J Dermatol. 1985;24:152–7. https://doi.org/10.1111/j.1365-4362.1985.tb05746.x.

    Article  CAS  PubMed  Google Scholar 

  37. Lipsky PE, Tao XL. A potential new treatment for rheumatoid arthritis: thunder god vine. Semin Arthritis Rheum. 1997;26:713–23. https://doi.org/10.1016/s0049-0172(97)80040-6.

    Article  CAS  PubMed  Google Scholar 

  38. Wang YN, Zhang Y, Wang Y, Zhu DX, Xu LQ, Fang H, et al. The beneficial effect of total glucosides of paeony on psoriatic arthritis links to circulating Tregs and Th1 cell function. Phytother Res. 2014;28:372–81. https://doi.org/10.1002/ptr.5005.

    Article  CAS  PubMed  Google Scholar 

  39. • Mavropoulos A, Tsiogkas S, Skyvalidas D, Liaskos C, Roussaki-Schulze A, Zafiriou E, et al. Delphinidin dose-dependently diminishes peripheral IL-17 and IFN-γ producing lymphocytes in psoriatic arthritis. Ann Rheum Dis. 2020;79(supplement 1):1124. This study demonstrated that in vitro treatment with delphinidin of peripheral blood mononuclear cells from patients with PsA led to reductions in IL-17 and IFN-γ production.

    Google Scholar 

  40. Pulido-Moran M, Moreno-Fernandez J, Ramirez-Tortosa C, Ramirez-Tortosa M. Curcumin and health. Molecules. 2016;21:264. https://doi.org/10.3390/molecules21030264.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Daily JW, Yang M, Park S. Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis of randomized clinical trials. J Med Food. 2016;19:717–29. https://doi.org/10.1089/jmf.2016.3705.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Skyvalidas DΝ, Mavropoulos A, Tsiogkas S, Dardiotis E, Liaskos C, Mamuris Z, et al. Curcumin mediates attenuation of pro-inflammatory interferon γ and interleukin 17 cytokine responses in psoriatic disease, strengthening its role as a dietary immunosuppressant. Nutr Res. 2020;75:95–108. https://doi.org/10.1016/j.nutres.2020.01.005.

    Article  CAS  PubMed  Google Scholar 

  43. Gelman L. 57% of arthritis patients have tried marijuana or cbd for medical reasons (and more than 90% say it helped) [Internet]. CreakyJoints. 2019 [cited 2020 May 4]. Available from: https://creakyjoints.org/eular-2019/medical-marijuana-cbd-usage-arthritis-patients-study/.

  44. Barrie N, Manolios N. The endocannabinoid system in pain and inflammation: its relevance to rheumatic disease. Eur J Rheumatol. 2017;4:210–8. https://doi.org/10.5152/eurjrheum.2017.17025.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Fitzcharles M-A, Ste-Marie PA, Häuser W, Clauw DJ, Jamal S, Karsh J, et al. Efficacy, tolerability, and safety of cannabinoid treatments in the rheumatic diseases: a systematic review of randomized controlled trials. Arthritis Care Res (Hoboken). 2016;68:681–8. https://doi.org/10.1002/acr.22727.

    Article  CAS  Google Scholar 

  46. Ko GD, Bober SL, Mindra S, Moreau JM. Medical cannabis - the Canadian perspective. J Pain Res. 2016;9:735–44. https://doi.org/10.2147/JPR.S98182.

    Article  PubMed  PubMed Central  Google Scholar 

  47. CBD Treatment in hand osteoarthritis and psoriatic arthritis [Internet]. clinicaltrials.gov. [cited 2020 May 20]. Available from: https://clinicaltrials.gov/ct2/show/NCT03693833.

  48. Impact of cannabis on pain and inflammation among patients with rheumatoid or psoriatic arthritis [Internet]. clinicaltrials.gov. [cited 2020 June 3]. Available from: https://clinicaltrials.gov/ct2/show/NCT04269993.

  49. Nascimento Menezes PM, Valença Pereira EC, Gomes da Cruz Silva ME, da Silva BAO, de Souza Duarte Filho LAM, de Lima Araújo TC, et al. Cannabis and cannabinoids on treatment of inflammation: a patent review. Recent Pat Biotechnol 2019;13:256–267. https://doi.org/10.2174/1872208313666190618124345.

  50. Lansky EP. Pharmaceutical and cosmeceutical compositions containing cannabis flower and seed extracts. 2010.

  51. Fitzcharles M-A, Rampakakis E, Sampalis J, Shir Y, Cohen M, Starr M, et al. Medical cannabis use by rheumatology patients following recreational legalization: a prospective observational study of 1000 patients in Canada. ACR Open Rheumatol. 2020;2:286–93. https://doi.org/10.1002/acr2.11138.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kendler M, Shimshoni R, Lasaroff I. Fallbericht: psoriasis vulgaris et osteoarthritis. Deutsche Zeitschrift für Akupunktur. 2004;47:46–8. https://doi.org/10.1078/0415-6412-00040.

    Article  Google Scholar 

  53. Chiu E. Psoriatic arthritis managed with multiple styles of acupuncture: a case report. Meridians. 2016;3:17–22.

    Google Scholar 

  54. Marchetti G, Vittori A, Mascilini I, Francia E, Picardo SG. Acupuncture for pain management in pediatric psoriatic arthritis: a case report. Acupunct Med. 2020. https://doi.org/10.1177/0964528420920281.

  55. Liao SJ, Liao TA. Acupuncture treatment for psoriasis: a retrospective case report. Acupunct Electrother Res. 1992;17:195–208. https://doi.org/10.3727/036012992816357611.

    Article  CAS  PubMed  Google Scholar 

  56. Chen P, Xin T, Zeng Y. Effects of acupuncture on Chinese adult patients with psoriatic arthritis: a prospective cohort study. Res Rev J Med Health Sci. 2017;6:19–23.

    CAS  Google Scholar 

  57. Singh JA, Guyatt G, Ogdie A, Gladman DD, Deal C, Deodhar A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol 2019;71:5–32. https://doi.org/10.1002/art.40726.

  58. Manyanga T, Froese M, Zarychanski R, Abou-Setta A, Friesen C, Tennenhouse M, et al. Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. BMC Complement Altern Med. 2014;14:312. https://doi.org/10.1186/1472-6882-14-312.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Green BN. Chiropractic management of a case of combined osteoarthrosis and psoriatic arthritis. J Sports Chiropract Rehabil. 2000;14:75–83.

    Google Scholar 

  60. Nelson NL, Churilla JR. Massage therapy for pain and function in patients with arthritis: a systematic review of randomized controlled trials. Am J Phys Med Rehabil. 2017;96:665–72. https://doi.org/10.1097/PHM.0000000000000712.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Bridget Jivanelli and Sarah Page from the Hospital for Special Surgery medical library for their assistance with the literature review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lisa A. Mandl.

Ethics declarations

Conflict of Interest

John Roberts IV has no conflicts of interest to disclose. Dr. Lisa Mandl has the following conflicts of interest to disclose: Annals of Internal Medicine (Associate Editor), UpToDate (Royalties), and Regeneron Pharmaceuticals (Research support).

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Complementary and Alternative Medicine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roberts, J.A., Mandl, L.A. Complementary and Alternative Medicine Use in Psoriatic Arthritis Patients: a Review. Curr Rheumatol Rep 22, 81 (2020). https://doi.org/10.1007/s11926-020-00956-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-020-00956-x

Keywords

Navigation