2015
LIVING WELL WITH
PSORIATIC ARTHRITIS
Presented by:
Barry Shibuya, MD
Introduction
Dr. Barry Shibuya
Board certified in Rheumatology, Internal Medicine, and most
recently
Integrative Medicine
Specializes in arthritis, osteoporosis and related autoimmune
diseases like lupus and rheumatoid arthritis
Washington Hospital (Fremont)
Overview of today’s talk
• Psoriatic arthritis as a whole-body condition
• Holistic medicine approach to psoriatic arthritis
• Healthy diet
• Safe use of supplements
• Exercise: benefits and strategies
• Sleep hygiene
• Self-care and dealing with stress
• Question and answer session
Psoriatic arthritis
• Psoriatic arthritis is an inflammatory type of
arthritis
• Causes stiffness, pain and swelling in and
around joints; surrounding ligaments and
tendons
• Can affect any joint in the body, and
symptoms vary from person to person
• Research has shown that persistent
inflammation from psoriatic arthritis can lead
to joint damage
Psoriatic arthritis and related diseases
Individuals with psoriatic arthritis are at an elevated risk to develop other chronic
and serious health conditions also known as “comorbidities”, including:
• Heart disease
• Diabetes
• Depression
• Metabolic syndrome
• Obesity
Healthy living with psoriatic arthritis
Because psoriatic arthritis is a whole-body condition, a good diseasemanagement plan incorporates:
• Treatment
• Healthy diet
• Regular exercise
• Stress reduction
• Strong support network
Holistic medicine vs. Western medicine
• Holistic medicine is a form of healing that considers the whole person -- body,
mind, spirit, and emotions -- in the quest for optimal health and wellness
• Searching for the underlying causes of disease is preferable to treating
symptoms alone
• Integrates conventional and alternative therapies to prevent and treat disease
• Optimal health is the priority over the absence of sickness
Remember
• A holistic approach does not replace
the need for Western medicine
• However, it can aid you in becoming
healthier and happier overall, and
perhaps lessen the need for
pharmaceutical intervention
Pharmacologic treatment options for
psoriatic arthritis
• NSAIDs (Nonsteroidal anti-inflammatory drugs)
• Aleve, Celebrex, Motrin, and many others
• DMARDs (Disease-modifying antirheumatic drugs)
• Methotrexate, sulfasalazine, Arava (leflunomide)
• Biologic agents (also DMARDs)
• Enbrel, Humira, Remicade, Simponi, Stelara
• Other treatment options
• Otezla, surgery, physical therapy
Benefits of early intervention
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Improve skin disease and joint function
Minimize disease progression
Ease pain and swelling
Lower risk of developing comorbid
conditions
• Better health outcomes overall
Tips to improve psoriatic disease
Ongoing care means:
• See your health care provider
• Take medications as prescribed
• Regular blood screenings
• Make lifestyle changes
See your health care provider
• Visit your health care provider / team as
prescribed
• Work with your health care provider to
find the best treatment options for you
Regular blood screenings
Visit your primary care provider regularly to check:
• Blood count levels
• Blood pressure
• Blood sugar
• Cholesterol
Psoriatic arthritis and diet
• No diet is scientifically proven to lessen symptoms of psoriasis or arthritis
• NPF Medical Board recommends eating a healthy, balanced diet:
• Variety of fruits and vegetables
• Whole grains
• Lean meats
• Low-fat dairy products
• Limited alcohol
• Healthy fats
Whole foods diet
• The standard American diet often includes too much sugar, white flour,
processed foods
• Following a whole food diet involves maximizing your nutrient intake from
natural sources and avoiding nutrient-poor processed foods
• Include plant-based foods
• Vegetables, fruits and nuts
• Animal foods
• Eggs, meat, fish and poultry
• A whole food diet can provide you with all of the nutrients you need for
optimal health
Weight loss diet
• Being overweight further compounds your risk for diabetes and heart disease
• To help identify what is a healthy weight for you, calculate your body mass
index (BMI)
• To lose weight, you need to burn more calories than you consume
• One pound equals 3,500 calories
• If you cut 500 a day from your diet, you will lose a pound a week
• People who lose weight slowly are more successful in keeping it off
• Can burn additional calories by increasing physical activity
Tips for preparing healthy foods
• When you feel like cooking, prepare extra to freeze
for leftovers so you always have healthy food
around
• Make sure any frozen entrees and canned soups
are low in sodium
• Consider pre-cut vegetables and fruits for healthy
snack options
• Pay close attention to portion size!
• The 9-inch “Plate Method” consisting of:
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Half vegetables
Quarter protein
Quarter starch
Dietary supplements
• Dietary supplements can be extracts or
concentrates, and they can occur in many
forms, such as tablets, capsules, softgels,
gelcaps, liquids or powders
• Tell your doctor before taking any OTC
supplements
• Every substance has a potential to interact
with your other medications and treatments
Omega-3 fatty acids (fish oil)
• Oils of cold water fish are rich in omega-3 fatty acids
• Fish accumulate omega-3 fatty acids by consuming either microalgae or
prey fish
• There are three types of omega-3 fatty acids:
• Alpha-linolenic acid
• Eicosapentaenoic acid (EPA)
• Docosahexaenoic acid (DHA)
• Fish oil appears to reduce inflammation in the body
• Used in many contexts, including:
• Conditions related to the heart and blood system
• To lower blood pressure or triglyceride levels
• Preventing heart disease or stroke
Food sources of omega-3 fatty acids
• Alpha-linolenic acid can be found in:
• Some vegetable oils
• Nuts, seeds
• Flax seeds, chia seeds
• Soy foods
• EPA and DHA:
• Found in fatty fish and algae
• Salmon, herring, mackerel, anchovies, and sardines
Vitamin D
• “The sunshine vitamin”
• Helps maintain healthy bones
• Assists with absorption and distribution of calcium in the body
• Speculation that vitamin D can help with aspects of health
• The prevention of cancer- this needs to be further elucidated however
• Maintenance of a normal and effective immune system
• Possibly with certain autoimmune diseases like multiple sclerosis
• Vitamin D can change the way cells grow
Food sources of Vitamin D
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Cod liver oil
Salmon (sockeye)
Mackerel
Tuna fish canned in water
Milk, non-fat, reduced-fat, and whole, vitamin D-fortified
Orange juice fortified with vitamin D
Yogurt fortified with 20 percent of the daily value of vitamin D
Eggs, vitamin D is found in the yolk
Swiss cheese
Fortified cereals
• Also– sunlight exposure (limited amount)
Turmeric (curcumin)
• Turmeric, a shrub related to ginger, is grown
throughout India, other parts of Asia, and
Africa
• Turmeric has been used to aid digestion
and liver function, relieve arthritis pain, and
regulate menstruation
• Preliminary findings from animal and other
laboratory studies suggest that a chemical
found in turmeric—called curcumin—may
have anti-inflammatory, anticancer, and
antioxidant properties
Glucosamine
• Glucosamine
• Natural chemical compound found in the body
• Most often used to try to ease the joint pain caused by
arthritis
• Helps keep the cartilage in joints healthy
• Glucosamine has been shown in some studies to help ease
the pain of mild to moderate osteoarthritis of the knee
• For other types of arthritis/pain, no evidence that glucosamine
helps:
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sports injuries, temporomandibular joint problems (TMJ), chronic
low back pain, etc.
Sleep
• Sleep is required for most essential body functions
• Poor sleep hygiene can lead to poor memory, concentration, problem solving,
emotional control, creativity, learning
• Tips from National Sleep Foundation:
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Avoid napping during the day
Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime
Exercise can promote good sleep
Food can be disruptive right before sleep
Ensure adequate exposure to natural light
Establish a regular relaxing bedtime routine
Associate your bed with sleep
Exercise
• Exercise can make a big difference in quality of life with psoriatic
arthritis
• Movement keeps joints and tendons looser and limber
• Helps reduce the inflammation and pain of psoriatic arthritis
• Building up muscles decreases the workload on joints
• Exercise can help lower the risk of developing a comorbid
condition
Vicious Cycle
Pain
Fatigue
Lack of
exercise
Psoriatic
Arthritis
Inactivity
Stiffness
Exercise and fatigue
• Studies demonstrate that even small amounts
of exercise, as little as 6 minutes per day, can
lessen pain and fatigue
• Regular exercise can increase energy levels
• Even among people suffering from medical
conditions like cancer and heart disease
• Researchers believe that putting forth more
energy into regular exercise may provide
increased energy in the long run
Exercise and mood
• Exercise can also help reduce anxiety and improve mood
• Exercise may help ease depression in a number of ways, including:
• Releasing feel-good brain chemicals that may ease depression (neurotransmitters and
endorphins)
• Reducing immune system chemicals that can worsen depression
• Increasing body temperature, which may have
calming effects
Exercise: getting started
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Consult your doctor to determine what is appropriate for you
Stretch out. Your workout should include 15 minutes of flexibility exercises
Build muscles by using weights or resistance
Find a buddy. Consider exercising in a group or with a friend to help you
stick with your regimen
• Make it fun. Start slow and focus on activities that you find enjoyable
Types of exercise
• Cardiovascular Exercise
• Strength Training
• Flexibility
Cardiovascular exercise
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High vs. low impact activities
30-40 minutes of moderate-intensity aerobic activity
Four to five days per week
Examples: brisk walking, cycling, swimming
Strength training
• Increase muscle strength surrounding joints
• Stability at joints
• Muscle-strengthening activities on 2 or more days a
week that work all major muscle groups
• Examples: free weights and resistance bands
Flexibility
• Increases ROM at a joint
• Decreases soft tissue tightness
• Prevents stiffness
• Can be done on a daily basis
Alternatives to regular exercise
routine
• Aquatic therapy
• Tai Chi
• Pilates and Yoga
Aquatic therapy
• Facilitates muscle relaxation and increases
circulation
• Water provides resistance for strength training
• Stimulates body awareness, balance, and trunk
stability
• Warm water and buoyancy results in decreased
pain sensitivity
Tai Chi
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Mental and spiritual aspects combined with movement
“Meditation in motion”
Low impact activity
Increases balance and decreases falls risk
Helps to improve muscle strength, flexibility, balance,
and aerobic conditioning
• Has demonstrated benefit for conditions including:
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Arthritis
Low bone density
Breast cancer
Heart disease
Heart failure
Hypertension
Parkinson’s disease
Stroke
Yoga and Pilates
• Combines controlled breathing, stretching and strengthening
exercises, and meditation to help control stress and improve blood
flow
• Can help build core strength, ease joint pain and improve range of
motion
• Practice yoga poses at least 15 to 20 minutes a day
Stay motivated
• Set realistic goals
• Do activities you enjoy
• Try and work exercise into your
daily life/routine
Modalities for pain
• Ice vs. heat
• Heat is best for painful joints, helps decrease joint stiffness
• Cold is best for warm swollen joints, helps decrease pain
with swollen joints
• Massage
• Massage can lower the body’s production of the stress
hormone cortisol
• Boost production of serotonin
• Lower production of the neurotransmitter substance P, often
linked to pain, and improve sleep as a result
Relief for pain and swelling in feet
• Find the right footwear: shoes with a
high toe box and/or heel cups can help
• Your insurance plan may cover
specialized shoes or orthotic inserts
• A podiatrist can fit you with footwear
specially made for you and provide
other solutions
Adaptive tools
• Number of tools available to help manipulate small
objects and/or perform repetitive motions
• Assistive devices help reduce stress on joints.
Devices include arthritic grip canes, crutches,
walkers, etc.
• For more information talk with your doctor,
pharmacist, physical or occupational therapist, or
the Job Accommodation Network for Assistance
Stress
• Stress is linked to the 6 leading causes of death:
• Heart disease
• Cancer
• Lung ailments
• Accidents
• Liver cirrhosis
• Suicide
• 43% of all adults suffer adverse health effects from stress
• 2/3 office visits to family physicians are due to stress-related symptoms
Signs of stress
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Poor judgment
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Pessimistic attitude
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Anxiety and worry
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Moodiness and irritability
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Agitation, inability to relax
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Loneliness and isolation
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Feeling overwhelmed, depressed and unhappy •
Aches and pains
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• Concentration and memory problems
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Diarrhea or constipation
Nausea, dizziness
Chest pain, rapid heartbeat
Loss of libido
Frequent colds
Eating more or less
Sleeping more or less
Procrastinating
Use of alcohol, cigarettes, or drugs to
relax
Increase in “nervous habits” like nail
biting or pacing
Self-perpetuating properties of stress
• Stress increases unhealthy behaviors
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Eat comfort foods
Smoke and drink alcohol more
Become more sedentary
Get less sleep
Less compliant with using medications
• Stress also increases negative thinking
The role of expectations
• When we don’t meet our expectations, we aren’t just unhappy, we feel
a danger or threat
• Important to understand what you control and what you don’t control
• Avoid “All or nothing” thinking, be realistic and reasonable
• I’ll get a job right away
• I’ll never get a job
The role of expectations
• Don’t set expectations too low, that’s a recipe
for feeling bad about yourself
• Aim for
• low expectations for things out of your control
• realistic expectations of things we have some
control over
• high expectations of ourselves
• Expect the unexpected
Self-appraisals are important
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Normal to compare ourselves to others
How you compare yourself is important
You are not better, they are not better
Everyone has their strengths
Reducing stress for people with
psoriatic arthritis
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Find a doctor you trust
Get better treatments/be proactive
Acknowledge your feelings
Talk to a friend or counselor
Educate yourself
See a psychologist
• Don’t be afraid to ask for help
• Set limits
• Learn to say “no”
• Spend time in nature
Relaxation, meditation, prayer
Social support
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National Psoriasis Foundation Team NPF events
Psoriasis One to One program
Volunteer
Online presence
Comment on blogs
Read and post on forums
Start your own blog
• Don’t assume people will be put off by requests for help.
People generally like to help, feel useful, and be needed
Take-home points
How we think about a situation is important
• Avoid catastrophic thinking
• Avoid all-or-nothing thinking
• Focus on positive aspects
What we
think
How we feel
What we do
Stress: what you can do
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Identify your stressors
Eliminate what you can
Reduce exposure
Say “No” to new obligations
Figure out how your appraisals may be contributing to how much stress
you feel
• Incorporate stress reduction techniques
• Treat your psoriasis and psoriatic arthritis!
Question & answer session