New Insights in Physical Therapy and Rehabilitation in Psoriatic Arthritis: A Review

Abstract

Psoriatic arthritis (PsA) is a complex, multiform and chronic inflammatory disease characterized by the association of psoriasis and arthritis with other musculoskeletal and extra-articular manifestations. The treatment of PsA is rapidly evolving due to the introduction of new biologic and small-molecule drugs, and the aim of treatment is to induce a condition of remission or low disease activity in all disease domains. However, unmet treatment needs still persist for those patients with impaired function, reduced quality of life or comorbidities. In this context, physical therapy and rehabilitation could provide additional benefits by reducing disease activity and improving function. Although a large number of studies have assessed the role of physical therapy and exercise in other forms of chronic inflammatory arthritis, such as axial spondyloarthritis and rheumatoid arthritis, evidence on their effect on persons with PsA is still lacking. However, some studies have reported the potential positive role of physical therapy on the different disease domains of PsA, in helping to improve disease activity, prevent or improve articular impairment, improve pain management and improve quality of life. Here, we review current evidence on physical therapy, exercise and rehabilitation in patients with PsA. In particular, we review the literature focusing on each domain, to provide evidence of efficacy and effectiveness of exercise and rehabilitation on skin, peripheral arthritis, axial involvement, dactylitis, enthesitis and comorbidities.

Difficult to Treat and Refractory to Treatment in Psoriatic Arthritis

“…The further validation and application of those concepts in clinical trials or the clinical context may help the physician to better understand the disease phenotype and course, which may allow better management of patients with PsA. In this context, more personalized treatment strategies which may include a non-pharmacological [ 29 ] approach could be implemented in patients with D2T.…”

Regular Exercise Improved Fatigue and Musculoskeletal Pain in Young Adult Psoriatic Patients without Psoriatic Arthritis

“…Improvement in both fatigue and pain may ultimately lead to improved function in patients with psoriasis [19,40,41]. Similarly, a recent systematic review and metaanalysis concluded that exercise interventions could reduce musculoskeletal pain which may lead to improved function in patients with other rheumatic and musculoskeletal diseases (RMDs) [42].…”

“…[16,18]. In this regard, evidence-based guidelines for the treatment of PsA recommend exercise as a non-pharmacological therapy to improve functional capacity [19,20].…”

Diet, sleep, and exercise in inflammatory skin diseases

“…Hence, beneficial effects of exercise seen in both psoriasis and DM may be mediated by reduction of TNF-alpha levels. Exercise is associated with reduced disease activity and improved functioning in patients with psoriasis [85]. Likewise, moderate intensity aerobic exercise is associated with improved muscle function, decreased disease activity, and higher quality of life among patients with DM [86].…”