January 28th, 2010
Before a client with psoriatic arthritis comes to you seeking relief, make sure you know about this condition and understand when massage might aggravate it.
by Nicole Cutler, L.Ac.
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Of all the types of arthritis, rheumatoid arthritis and psoriatic arthritis are among the most disabling. While many bodyworkers are familiar with rheumatoid arthritis, much fewer have an understanding of psoriatic arthritis. Because improperly applied massage therapy during a certain stage of psoriatic arthritis can exacerbate the pain, practitioners who know about this condition are best able to help affected clients.
Affecting approximately seven million Americans, psoriasis is a common, non-contagious skin condition. Unpredictable and irritating, psoriasis is characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plaques covered with silver-white scales. Frequently appearing in cycles of flare and remission, psoriatic flare-ups often cause considerable itching.
Although the exact cause is not known, psoriasis commonly runs in families. Aside from the possibility of a genetic susceptibility, most doctors believe that psoriasis involves the immune system. This is because an increased number of white blood cells are present between the psoriasis skin layers and because this skin condition responds to immunosuppressant drugs. In addition, the following factors may contribute to psoriasis development, worsening or flare-ups:
- Cold, dry weather
- Skin injury
- Stress and anxiety
- Certain medications
Although there are rarely any dangerous complications of this skin disorder, approximately 10 percent of people with psoriasis are at risk for a painful and possibly extreme form of arthritis, called psoriatic arthritis. General symptoms of psoriatic arthritis include:
- Pain in affected joints
- Swollen joints
- Joints that are warm to the touch
Just like psoriasis, psoriatic arthritis typically cycles between flare-ups and remission. Often, the skin and joint problems appear and disappear at the same time. There are five identified types of psoriatic arthritis:
- Asymmetric – This is the mildest form of psoriatic arthritis, and it usually affects less than five joints on one side of the body; typical culprits are the hip, knee, ankle or wrist.
- Symmetric – Usually affecting five or more joints on both sides of the body, symmetric psoriatic arthritis is more common in women and tends to be severe.
- Fingers and Toes – Distal interphalangeal (DIP) joint predominant psoriatic arthritis is rare and occurs mostly in men. This type of arthritis affects the small, distal joints in the fingers and toes and often causes thickening, pitting and discoloration of the nails.
- Spine – Called spondylitis, this form of psoriatic arthritis causes inflammation in the spine as well as stiffness and inflammation in the neck, lower back and sacroiliac joints.
- Destructive – A small percentage of people with psoriatic arthritis have a severe, painful and disabling form called arthritis mutilans. Over time, arthritis mutilans destroys the small bones of the hands, especially the fingers, leading to permanent deformity and disability.
Because there is no cure for psoriatic arthritis, treatment is focused on controlling inflammation and preventing joint pain and disability. Often, a multidisciplinary approach is used to help both skin and joint symptoms.
Because the origins are not yet understood, healthcare providers can help their clients with psoriatic arthritis the most by looking at what precipitates a flare-up. Typically, symptoms bloom during periods of great stress or anxiety. While massage therapists can’t do much about the client’s medications, weather, preventing skin injury or infections, they can help their client achieve a relaxed state.
For massage therapists, psoriatic arthritis is treated the same as rheumatoid arthritis:
- Avoid areas that are hot and inflamed.
- Strive for joint mobility and pain reduction when there is no active inflammation.
When a client is having a psoriasis flare-up, the affected cells are hyperactive. Thus, increasing energy or circulation in that area could aggravate the condition. Therapists must remember that psoriasis can also be triggered by skin trauma. Accordingly, bodyworkers need to make sure their client immediately communicates if he or she feels any discomfort. After considering these two cautions, massage therapy can help alleviate the psoriatic arthritis trigger of stress. And just like for osteoarthritis, massage can reduce pain and stiffness in areas that are not currently inflamed.
Armed with the knowledge of what psoriatic arthritis is, when massage can benefit it and when to steer clear of painful joints, massage therapists will be better prepared to help clients affected by this potentially debilitating skin and joint disorder.
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http://www.everydayhealth.com/psoriatic-arthritis/psoriatic-arthritis-physical-therapy.aspx, Psoriatic Arthritis and Physical Therapy, Retrieved March 13, 2009, Waterfront Media, Inc., 2009.
http://www.massagetoday.com/mpacms/mt/article.php?id=13477, Dealing with Psoriasis, Ruth Werner, LMP, NCTMB, Retrieved March 13, 2009, Massage Today, September 2006.
http://www.mayoclinic.com/health/psoriatic-arthritis/DS00476, Psoriatic Arthritis, Retrieved March 13, 2009, Mayo Foundation for Medical Education and Research, 2009.
http://www.medscape.com/viewarticle/571284, Comparative Effectiveness of Drug Therapy for Rheumatoid Arthritis and Psoriatic Arthritis in Adults: AHRQ Executive Summary, Retrieved March 15, 2009, Agency for Healthcare Assurance and Quality, March 2008.
http://www.webmd.com/skin-problems-and-treatments/psoriasis/understanding-psoriasis-basics, Psoriasis, Retrieved March 15, 2009, WebMD, LLC, 2009.
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