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Another primary anti-inflammatory herb is curcumin, an extract from turmeric. Unlike nettles and boswellia, this herb doesn't appear to affect TNF-a levels; however, it inhibits PGE2 production at sites of inflammation and suppresses IL-1, which not only decreases joint inflammation in PsA, but also blocks osteoclasts and decreases bone destruction, a problematic and typically irreversible effect of the disease.37
Because of the close connection between stressful events and flare-ups or worsening of symptoms with both psoriasis and psoriatic arthritis, management and modulation of the stress response is often an important part of a comprehensive treatment plan. As mentioned, PsA patients have been shown to have a blunted HPA response to stress.38 One of the primary physiologic roles of cortisol is to aid in the control or blunting of an immune response. When cortisol levels are elevated, or when pharmaceutical glucocorticoids are employed, suppression of the immune system is seen. Conversely, when the HPA axis is dampened and cortisol output is diminished, the immune system has lost one of its gatekeepers and autoimmune disease is common. Herbs that fall into the general category of adaptogens include (but are not limited to) Rhodiola rosea, Schisandra chinensis, Eleutherococcus senticosus, and Glycyrrhiza glabra (licorice root). These therapies aid in the production of cortisol and with patients' ability to cope with life-stress symptoms.39,40 Additional considerations for supporting a healthy stress response are B vitamins, specifically pantothenic acid (B5) to support normal adrenal cortex function and pyridoxine (B6) to modulate a healthy stress response.41,42 Voluntary, slow deep breathing acts to reset the autonomic nervous system and calm a stress response and should be an important part of any stress management system.43
Not only can the inflammatory processes lead to psoriatic arthritis and irrevocably damage the joints, there is also a significantly increased risk of cardiovascular disease and metabolic syndrome in psoriasis patients due to the active inflammatory activity. A recent meta-analysis concluded that psoriasis is associated with an estimated 11,500 major adverse cardiovascular events each year.44 Because inflammation often goes on "behind the scenes" until irreversible damage has occurred, regular screening for cardiovascular and articular changes is needed in patients with psoriasis as well as those with a family history of psoriasis. Treatment should always include efforts to limit systemic inflammation, and there are many alternative therapies and lifestyle modifications that can be used in lieu of or in addition to pharmaceutical management of these conditions. The National Psoriasis Foundation reports that patient satisfaction with their current treatment is under 50% and natural therapies are among their top searched for terms, indicating that there is significant need for an integrative treatment approach. It's important that neither patients nor physicians ignore the underlying immune dysfunction that occurs with psoriasis. As with many degenerative conditions, preventative measures and early intervention are key to successful outcomes. It turns out that psoriasis, like beauty, is not skin deep.
Figure 2: Examples of common conventional and alternative therapies and their mechanisms for treating psoriatic arthritis and systemic inflammation. (pdf)
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Dr. Wood grew up in Colorado and obtained her undergraduate degree in biochemistry from Colorado College. An enthusiasm for science but a passion for people led her to medicine, and a desire to treat the cause of disease, not just the symptoms, led her to naturopathy. After completing her doctorate at the National College of Naturopathic Medicine, Dr. Wood stayed in Oregon and has a private practice focused on endocrine imbalance, digestive dysfunction, immune support, and cardiovascular health.
In addition to her clinical practice, Dr. Wood is a staff physician with Labrix Clinical Services Inc., where she educates physicians and health care providers around the country about hormonal balancing through development of educational materials, contributions to a webinar series, and lectures at local and national conferences. In 2008 she coauthored a book on andropause titled His Change of Life: Male Menopause and Healthy Aging with Testosterone.
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