Psoriatic Arthritis: Therapy

General measures

  • Avoid dehydration and irritation of the skin by balancing skin care. Suitable care products are a greasy skin care in combination with keratolytics.
  • Observance of the general hygiene measures!
  • Nicotine restriction (refrain from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Review of permanent medication due topossible effect on the existing disease – beta blockers can worsen psoriasis.
  • Avoidance of psychosocial stress:
    • Stress
  • Avoidance of environmental stress:
    • Avoidance of chemical and mechanical skin irritation.
    • Thermal skin irritation such as sunburn.

Conventional non-surgical therapy methods

  • Radiosynoviorthesis (RSO, from radioactive isotope, synovial joint lining, orthotic restoration; RSO for short) is one of the nuclear medicine procedures used therapeutically in rheumatology and orthopedics for the treatment of chronic inflammatory joint diseases. The application of radiosynoviorthesis provides the possibility of reconstruction of the synovium (inner lining of the joint cavity without cell contacts). The reconstruction of the synovium is based on the use of beta-emitters (radionucleotides). The beta rays significantly reduce local hyperemia (increased blood supply) and induce inactivation of existing inflammatory cells. Furthermore, the destructive (devastating) effect of the beta rays causes a connective tissue transformation of the synovium (synovial membrane). This can last up to three months. To avoid additional infection, the injection of the radioactive substance is performed under strictly aseptic conditions and X-ray fluoroscopy. Parallel to the radioactive substance, a steroid (inflammation inhibitor) can also be applied.If the treatment takes place at a later stage, the chances of success are significantly reduced.
  • A possible form of treatment for psoriasis is PUVA (psoralen plus UV-A). Here, a substance called psoralen is applied to the affected skin area, which sensitizes the skin to sunlight and UV radiation and then irradiated with UVA light. Irradiation without this substance with UVA or UVB light is also possible and is called selective ultraviolet irradiation (SUB).
    • Indication: induction therapy for moderate to severe psoriasis vulgaris, especially if large areas.
    • Side effects: Skin irritation with erythema (skin redness), itching; hyperpigmentation, blistering; oral PUVA: nausea.
    • Contraindications: increased photosensitivity, increased risk of skin cancer, ciclosporin (cyclosporin A), pregnancy / lactation; relative: seizure disorders, photosensitizing drugs, skin malignancies in the anamnesis, limitation of physical / psychological resilience, compliance ↓; relative for PUVA: severe liver damage, Z.n. therapy with ionizing radiation, arsenic, high cumulative UVA dose.
    • Combination with topical vitamin D3 derivative may be recommended; furthermore, combination with corticoids and dithranol.
    • No long-term therapy

Medical aids

  • If necessary, supply of assistive devices such as button aid, pen thickening, etc.

Regular check-ups

  • Regular medical checkups

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
    • High-fiber diet (whole grains, vegetables).
  • Observance of the following special dietary recommendations:
    • Keep intake of arachidonic acid (omega-6 fatty acid) low, as it promotes inflammatory processes. It is contained in animal foods, especially pork and pork products and tuna.
    • Increase the intake of eicosapentaenoic and docosahexaenoic acid (EPA and DHA; omega-3 fatty acids) to promote the formation of anti-inflammatory substances in the body.They are contained in fatty marine fish such as salmon, herring and mackerel.
  • Selection of appropriate foods based on the nutritional analysis.
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training).
  • To maintain function, diseased joints must be moved: Functional training, rehabilitation sports and especially slow sports reduce pain and improve their mobility.
  • In general, sports with slow movements – such as swimming, Nordic walking, cycling – are more suitable, and the training sessions should be frequent and short for this. If many joints are inflamed, offers exercise therapy in warm water.
  • Muscle training is equally necessary. Because a strong musculature stabilizes and relieves the joints. Muscle training, however, only under physiotherapeutic guidance and only in quiet phases of the disease.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Physical therapy (including physiotherapy)

The following therapeutic measures are used in addition to drug therapy. They aim to improve joint mobility, maintain function and thus increase the quality of life of patients in the long term:

  • Physiotherapy/movement therapy.
  • Cryotherapy (cold therapy)
  • Phototherapy (light therapy) – Both natural sunlight, for example in the mountains or by the sea, and an artificial light source can be used.
  • Serial water-filtered infrared A whole body irradiation.

Psychotherapy