Psoriatic Arthritis Requires More Support Than Big Pharma Media Pitches

Monday, May 18, 2015
By: Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

The TV commercial describing the professional golfer with psoriatic arthritis makes it sound like taking a blockbuster prescription drug will cure all the ills of the autoimmune disorder psoriatic arthritis. From the itchy, dry, red patches or white scaly plaques to the pitted, thickened, ridged fingernails to the swollen painful joints, the commercial paints the picture that the drug will make everything better and there is nothing to worry about. The disease will be gone and life can go on. For those who struggle with psoriasis and psoriatic arthritis, the autoimmune disorder has far-reaching consequences. A much larger problem exists with psoriatic arthritis than big pharma leads us to believe in the cure-all advertisements.

Psoriatic arthritis (PA) is an autoimmune disease that involves skin breakdown with painful, itchy red and silvery plaques that build up on the skin, often on the elbows, knees, scalp, and sometimes the torso. The non-contagious skin breakdown in psoriasis usually first appears between the ages of 15 and 25, but it can happen at any age. The erosion and destruction of joints, or psoriatic arthritis, occurs about ten years after the onset of psoriasis. Psoriatic conditions affect over seven million Americans.

Psoriatic Arthritis and Gut Health

Early PA research from 1983 revealed links with a non-beneficial gut bacteria overgrowth - Klebsiella and Yersinia. The presence of the HLA-B27 antigen and gene was linked with PA and many other types of arthritic disorders but the trigger mechanism was unknown. Fast forward thirty-plus years to see what researchers have recently learned. HLA-B27 is still a major risk factor for PA and other autoimmune arthritis problems. New research within the last several months has identified some of the mechanisms. A surprising finding is that the altered gut microbiome may not have any digestive or gut symptoms especially early on in the disease process, however, HLA B27 gene is triggered by the non-beneficial bacteria in the gut. This process ends up triggering dendritic cells and inflammatory cytokines to destroy tissues outside the digestive tract in what is known as the “skin-joint-gut” axis. American College of Rheumatology scientists have identified that the bacterial population has poor diversity in PA patients. Not only was there a less diverse bacterial population, there were substantially less beneficial bacteria present. This aspect of PA is certainly not addressed by the drug of choice on the TV commercial.

Another new discovery for psoriatic arthritis is how a compound called Th17 plays a crucial role in this “skin-joint-gut axis”. Researchers now know that TH17 and its related cytokines IL-17 and IL-22 cause bones to erode, leading to the arthritis in PA. This is a major update, as PA used to be thought of as a TH1 dominant disorder. About a decade ago, a common thought process that still is used somewhat today was to focus on the balance of TH1 and TH2. The immune system was thought to balance on these two arms or groups of T-cells like a teeter-totter. This finding of how TH17 dominance and how it causes the pathology opens the door to a different nutritional support process briefly discussed later in this article.

As the numbers of autoimmune disorders and those struggling with autoimmune disorders continue to climb, research is exploding with understanding complex relationships with other factors that were previously unknown. There are some very striking things that coincide with psoriatic arthritis that all people with autoimmune disorders and their health care practitioners need to monitor and support.

Obesity Increases Disease Process

The incidence of obesity has correlated with the dramatic increase of autoimmune diseases in the Western countries along with many of the environmental and food concerns of modern age. A research literature review study looked at over 300 articles and found that the presence of obesity and high level adipokines, such as leptin and adiponectin, was nearly a sure way to develop many autoimmune disorders. Fat cells are not a passive problem; rather the presence of excess inflammatory chemicals from the excess weight accelerates the process of tissue damage.

The strongest relationship occurred in those who had psoriasis and psoriatic arthritis along with rheumatoid arthritis and were obese. Problems with type I diabetes, thyroid autoimmunity, especially Hashimoto’s thyroiditis, and inflammatory bowel disease are also heavily influenced by adipokines. Not only did the obesity worsen the disease process including PA, it also impaired the treatment response. Imbalanced gut bacteria and problems with LPS (toxins from the gut bacteria) provoke obesity and inflammation within the gut and elsewhere in the body. This triggers problems with things like insulin resistance and fatty liver disease. As you will see below there is a correlation with insulin resistance, fatty liver disease, and other problems. It all comes back to the gut.

PA Linked with Thyroid, Hair Loss, Celiac, Diabetes, Heart Disease and More

Autoimmune thyroid disorders and alopecia areata (autoimmune hair loss) is also associated with PA. Scientists recommend that all autoimmune thyroid patients be accurately monitored for other autoimmune disorders including PA. Celiac disease patients have a much higher occurrence of psoriasis and PA. Individuals with non-alcoholic fatty liver disease and metabolic syndrome are likewise at risk for psoriasis and psoriatic arthritis. Underlying these autoimmune disorders with imbalanced gut flora, TH17, and the triggering of the HLA genes is increased gut permeability.

Studies also show that the more severe psoriatic arthritis is, the higher the risk for heart attack, type II diabetes, and atherosclerosis. One study showed that nearly sixty percent of patients with PA had metabolic syndrome which seriously increased the risk for diabetes and heart attack. Another study showed that at least thirty-five percent of PA patients had hypertension and high blood sugar or metabolic syndrome.

PA Linked with Bone Loss

If this wasn’t difficult enough, young adults in their 30’s with PA often have osteopenia. A study identified that over fifty-five percent of PA patients have lost bone mineral density. Men more so than women, oddly enough, are likely to have osteoporosis even in their 30’s. This was due to the presence of altered vitamin D metabolism and antibodies with tissue transglutaminase IgA (Celiac disease).

Building a Tool Box for Psoriatic Arthritis Support

PA and psoriasis are symptoms of autoimmune inflammation with connections to metabolic syndrome with high blood pressure and high blood sugar, leptin and adipokine imbalances, fatty liver congestion, gut bacteria imbalances like H pylori and Helicobacter, environmental toxins, and other major factors. It is not just a difficult, unsightly skin disorder with arthritis. It is a conglomeration of many things gone terribly awry in the body with underlying gene signals switched on by high levels of TH17, other cytokines, TNF-a, interleukins, and more. Taking the popular prescription drug to block various cytokines and reduce the symptoms is the medical approach to treatment, but it does nothing to address the big picture. 

In order for PA patients and others who struggle with autoimmune arthritis problems, it is vital to work on the whole picture. Restore healthy gut bacteria with beneficial bacteria from fermented foods and probiotic supplements. Reduce the non-beneficial bacteria with nutrients like oregano oil, noni, olive leaf extract, cranberry extract and monolaurin that help support healthy flora in the gut. Nutrients like glutamine and NAGs (N-acetyl-d-glucosamine) help support a healthy gut mucosal lining. The omega 3 and 6 oils EPA, DHA, and GLA offer protection against inflammation in PA. They help to balance out excess arachidonic acid that intensifies pain production and help protect the cartilage, joints, and bones from inflammation. Arachidonic acid is found primarily in high vegetable oil (soy, corn, safflower, sunflower, canola, cottonseed, etc) and meats. We usually get far too much of it compared to the good omega-3 oils.

Balancing the TH17 signal and triggered inflammation is supported with immune stabilizing glutathione with nutrients such as NAC, glutamine, and R-alpha lipoic acid, beneficial bacteria, fish oil, resveratrol, and curcumin. Research showed that incorporating nutrients like the resveratrol, and other nutrients such as coenzyme Q10, lipoic acid, vitamin E, and selenium helped reduce the problems with the psoriasis and the dangerous association with metabolic syndrome, allowing improved effects of the prescription drug therapy for PA.

Managing adiponectin and leptin is another key area to focus on. Magnesium is one tool that helps support healthy adiponectin levels. Many other resources exist for leptin and adiponectin. Nutrients like pine nut oil, tocotrienols, pantethine, and cinnamon, along with strength training, help support healthy liver function and reduce risks associated with non-alcoholic fatty liver disease or fatty liver congestion.

Preventing the debilitation from psoriatic arthritis and psoriasis needs a big tool box. Start with the gut and reduce the inflammation. Plastering oneself with creams, wearing long-sleeve shirts, feeling embarrassed when shaking hands or checking out at the grocery store, and struggling with debilitating joint pain should not have to be the norm with PA. PA reflects many different things out of balance in the body. No single drug can provide this type of support to help restore health. With this multi-dimensional view of a complex disorder, more individuals can take charge of their health. Healing has to come from the inside out and it can be done.

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