What is a good alternative medicine treatment for a psoriatic arthritis flare-up?

Alternative Medicine Treatments for Psoriatic Arthritis Flare-ups

For psoriatic arthritis flare-ups, intra-articular glucocorticoid injections are the most effective alternative medicine treatment option, particularly for localized disease affecting single joints. 1

First-line Alternative Treatments

Local Glucocorticoid Injections

• Intra-articular steroid injections are highly effective for:
  • Mono/oligoarthritis (few affected joints)
  • Single joint flares in otherwise controlled polyarthritis
  • Dactylitis (sausage digits) via tendon sheath/peritendinous injections
  • Enthesitis (inflammation where tendons/ligaments attach to bone) 1

Cautions with Injections

• Must be given judiciously to treat persistently inflamed joints
• Avoid injection through psoriatic plaques
• Limit repeated injections to the same joint according to clinical judgment 1

Systemic Glucocorticoids

Low-dose systemic glucocorticoids (≤7.5 mg/day of prednisone) may be considered with caution:

• Registry data shows up to 30% of PsA patients use systemic steroids 1
• FDA approved for psoriatic arthritis as short-term adjunctive therapy 2
• Should be used with particular caution if:
  • Patient has severe/extensive skin involvement
  • Patient is not taking concomitant DMARDs 1

Important Risks

• Potential to cause post-steroid psoriasis flare
• Not recommended for chronic use
• Long-term use can lead to major adverse events 1
• Tapering should be done carefully to avoid skin disease rebound 1

Traditional Chinese Medicine

For patients interested in complementary approaches:

• Herbal methods may be considered if ingredients are known and well understood
• Acupuncture has shown relatively minor responses in mild to moderate disease 1
• Ensure any herbal remedies are used alongside conventional treatments, not as replacements

Coal Tar Preparations

• Recommended for treating the skin manifestations in mild to moderate psoriasis 1
• Goeckerman therapy (combination of coal tar and UV light) may be beneficial for certain patients 1

Dietary Approaches

• Dietary modifications are commonly used by patients to mitigate symptoms 3
• Omega-3 fatty acid supplements have shown some positive results 3

Treatment Algorithm for Flare Management

1. For localized joint involvement (1-2 joints):

   • Intra-articular glucocorticoid injections as first choice 1

2. For more widespread joint involvement:

   • Short course of low-dose systemic glucocorticoids (prednisone ≤7.5 mg/day) with careful monitoring 1
   • Always consider adding or optimizing a DMARD to prevent steroid dependence 1

3. For skin-predominant flares with joint involvement:

   • Coal tar preparations for skin manifestations 1
   • Cautious use of systemic steroids if skin involvement is severe 1

4. For patients preferring complementary approaches:

   • Consider well-studied herbal preparations or acupuncture as adjunctive therapy 1, 3
   • Ensure these are used alongside, not replacing, conventional treatments

Important Considerations

• Alternative treatments should generally be considered adjunctive to disease-modifying drugs
• The primary goals in PsA treatment are pain reduction, improvement of symptoms, optimization of function, and inhibition of joint damage 4
• Regular collaboration between dermatologists and rheumatologists yields more optimal control of both skin and joint symptoms 5
• If alternative approaches are insufficient, progression to conventional DMARDs or biologics may be necessary 1