Psoriatic arthritis (PSA), a chronic inflammatory condition characterized by typist, enthesitis, peripheral arthritis, skin and nail psoriasisand the spondylart that occurs in approximately 10% -30% people with psoriasis. Although there are several pharmacological treatment strategies, the PSA continues to have a significant impact on patient pain levels, functional capacity and mental well-being.
With joint and skin manifestations, the PSA is associated with several comorbidityIncluding cardiovascular disease (CVD), central awareness syndrome, diabetes mellitus, dyslipidemia, foie gras disease, dropinfections, Inflammatory intestine diseasekidney disease, metabolic syndrome,, obesityOsteoporosis and uveitis, which all have a negative impact on the quality of life (QOL). PSA patients are also more likely to feel psychological problems, such as Anxiety and depression. Given these challenges, non -pharmacological interventions play a key role in disease management. Healthy lifestyle changesIncluding food modifications, regular exercise and cessation of smoking – as well as psychological interventions – are essential to improve PSA and quality of life. Here are current non -pharmacological interventions that can improve the symptoms and quality of life of PSA patients.
In their treatment guide, the American College of Rheumatology and National Psoriasis Foundation (ACR / NPF) recommend non -pharmacological interventions for PSA, including acupuncture, low impact exercise, massage, occupational therapy, physiotherapy, smoking and weight loss despite weak evidence For everyone, except smoking cessation.
The importance of physical activity in reducing inflammation
Physical activity and targeted exercises play an important role in reduction Inflammation, severity of the disease and results in PSA patients. Studies have discovered that exercise, especially when combined with food changes, can improve APS symptoms. THE ACR / NPF Recommend a low impact exercise on a high impact exercise for PSA management. In their guideline, the European alliance of associations for rheumatology Note regular physical activity as an integral part of care for PSA patients.
Regular exerciseIncluding resistance training, aerobic and flexibility exercises can improve and preserve joint function, reduce inflammation and improve quality of life in PSA patients. A randomized parallel controlled trial in parallel to a single blind 12 weeks per Silva et al Functional training and resistance training have in the same way found the activity of the disease, functional capacity, functional state, general quality of life and muscle strength in patients with PSA.
The link between food and inflammation in the PSA
Dietary interventions focused on weight loss, reduce mechanical tension on joints and reduce the risk of MCV in PSA patients. It has also been shown that weight loss Improve the activity of the disease. Moreover, research Suggest certain food changes, as well as exercise, can improve the results of PSA disease regardless of weight loss. Diet rich In saturated fats or certain omega-6 fatty acids while anti-inflammatory diets can improve APS symptoms and disease activity. Among various anti-inflammatory regimes, the Mediterranean regime has won the most popularity because the studies have found it associated with Weaker disease activity in PSA patients.
According to the National Psoriasis Foundation medical advicePSA patients can consider the Mediterranean diet at the trial conjunction With pharmacotherapy. The NPF medical advice also emphasizes the increased intake of fiber, complex carbohydrates, monosaturated fatty acids and omega-3 fatty acids. Although other food interventions for improving the PSA are less studied, a case report by Lewandowska et al I found an entire vegan diet improved the symptoms of PSA a 40 -year -old woman. However, additional research is necessary to confirm the role of vegetarian or vegan diets in modulating the activity of PSA disease.
Smoking: What role does he play?
The association between smoking and the development of the PSA remains inconclusivewith studies giving mixed results. At population levelSmoking is positively associated with PSA. However, some studies suggest that smoking increases the risk of developing a PSA, while others do not indicate significant association Between smoking and the progression of joint lesions. Beyond the start of the disease, smoking has been linked to less good treatment results in PSA. An observational cohort study by Højgaard et al noted that patients with smoking PSA had poor answers to treatment with inhibitors of the tumor-α necrosis factor and were also less likely to adhere to their treatment plan. In addition, smoking is a risk factor For MCVs and other common comorbidities in the PSA. Consequently, tobacco stopping is an important intervention in the lifestyle for patients with PSA – not only to improve treatment efficiency but also to reduce the risk of other comorbidities, thus improving quality of life.
Integration of weight management in PSA care
The relationship between PSA and obesity seems to be bidirectional: Research has shown that obesity is a common risk factor to develop a PSA and that joint dysfunction and reduced physical activity due to the PSA itself can cause weight gain. Patients with PSA and obesity often have higher disease activity and poor response to treatment. An interventional study of Klingberg et al has shown a weight loss treatment with a very low diet improving the activity of the disease, pain, fatigue and C-reactive proteins in patients with PSA and obesity. Likewise, another study of Klingberg et al Also reported an improvement in the activity of PSA disease after 12 months of weight loss treatment.
In addition to diet and exercise, GLP-1 and agonists of insulinotropic polypeptid receptors dependent on glucose and incredine Associated with weight loss can benefit patients with PSA and obesity. However, research on the effect of these drugs on the PSA is still quite limited and requires a more in -depth investigation.
The bidirectional link between sleep and inflammation
In addition to obesity, there also seems to be a bidirectional relationship between the PSA and sleep disturbances. Persistent sleep disorders in the PSA can be interconnected With an inflammatory activity of the disease, chronic pain, fatigue and psychological distress, creating a vicious circle where each factor intensifies others. A prolonged and significant decrease in the quality of sleep reduces the quality of overall life and increase the risk of a patient to develop MCVs, hypertensionand metabolic disorders, comorbid conditions associated with PSA. Prolonged deterioration in the quality of sleep can have a negative impact on the quality of life of PSA and PSA patients and increase The risk of developing hypertension, MCV and metabolic disorders.
Several lifestyle changes Can help improve sleep quality in PSA patients. These include maintaining regular cycles and sleep balance, limiting alcohol and caffeine Contribution and improvement of the patient’s sleep environment. In addition, drugs used to treat PSA – as Guselkumabtumor necrosis factor inhibitors (Adalimumab,, Certolizumab Pegol,, tutoring,, golimumab,, infliximab), and the inhibitor of Janus Kinase Filgotinib – have shown potential in improving sleep results in PSA patients.
The PSA psychological burden
Pain, fatigue, anxiety and depression are common psychological comorbidities of the PSA which have a negative impact on the quality of life. THE odds to be diagnosed with behavioral and mental health disorders is higher in PSA patients compared to the general population. Even with treatment, studies have shown that PSA affected Emotionally, socially and professional patients underline the importance of full management, because the targeting of the inflammatory activity of the PSA alone may not improve the quality of life.
Cognitivo-behavioral therapy is a well-established psychological intervention which can improve Symptoms of depression, anxiety and sleep disorders in patients with PSA. It can also improve the quality of sleep in patients with PSA. Although research is limited, the effectiveness of cognitive behavioral therapy (TCC) to improve psychological distress can in turn improve overall quality in PSA patients. Although research on this subject is limited, TCC can be beneficial Improve mood disorders and the overall quality of life of PSA patients.