(uplifting music)
- Hi, my name is Dr. Dana DiRenzo.
It's common for patients with chronic diseases
to want to try as many therapies as possible,
especially if they are in pain,
whether they are prescription therapies from their doctor
of complimentary and alternative therapies
available in the community or over the internet.
However, it is always important
to talk to your treating physician
about all the substances and activities you may take
and participate in for your arthritis.
The American College of Rheumatology
issued a position statement in 2012
recognizing the interest of both patients and physicians
in use of complimentary and alternative medicines.
Generally, in terms of psoriatic arthritis,
there are very little scientific studies
regarding the effectiveness of complimentary
and alternative therapies.
There is some evidence with regards to herbs, supplements,
creams, and mind/body practices for relief of psoriasis.
(uplifting music)
Mahonia aquifolium, also known as Oregon Grape.
The most common side effects of topical treatment
include rash and a burning sensation
when applied to the skin.
Traditional Chinese herbal medicine.
There is some evidence that using TCMs
like Chinese foxglove, red sage, purple gromwell
in addition to traditionally prescribed medications
and light therapy may be more effective
than conventional treatment alone.
On the other hand, patients call in all the time
asking about coconut oil.
In combination with UV light treatment,
was not found to clear psoriasis plaques faster
in the only clinical trial it was studied in.
Side effects with combination therapy
may include GI upset, elevated liver enzymes,
and elevated cholesterol.
Patients frequently drink green tea,
which contains caffeine, which may improve mental alertness.
However, there are no clinical trials to date
assessing the effectiveness of green tea
for treating psoriasis or psoriatic arthritis.
Liver toxicity has been reported
if you are drinking large quantities of green tea
but green tea is generally safe.
Kombucha tea, this popular drink
commonly sold in health stores is produced
by fermenting the kombucha mushroom in tea and sugar.
However, there are no scientific studies published
with regards to proven health benefits
in psoriasis or psoriatic arthritis.
There are rare serious side effects
from drinking large quantities of this beverage
including impaired liver function,
especially for patients with preexisting liver damage.
Other effects include allergic reactions
and nausea and vomiting.
As a side note, if you are on medications
that are processed through your liver, such as methotrexate,
it is always important to keep in mind
herbs and supplements that may affect your liver.
Patients also frequently ask about tumeric,
ginger, cinnamon.
There is very little evidence that tumeric is effective
for psoriasis specifically
but it is known to have antiinflammatory properties
in other diseases.
Patients should use caution with long-term use
and at high doses and this may cause gastrointestinal upset.
Ginger, also frequently used.
Ginger has not been studied in psoriasis
or psoriatic arthritis specifically,
but has been shown to help with nausea
that some patients may experience while taking methotrexate.
In terms of ginger, caution should be noted
with patients with gallstone disease
as ginger may increase the flow of bile
and for those on blood thinners.
There is an unclear certainty of drug interaction.
Cinnamon is frequently asked about.
There are no clinical trials evaluating cinnamon
for psoriasis specifically.
There are a small number of trials in mice
that have found antiinflammatory properties
of cinnamon, however.
Cinnamon contains coumarin
which may cause impaired liver function
and should be used with caution,
especially if you are prescribed an arthritis medication
that is metabolized in the liver.
These medications not only include methotrexate
but also include leflunomide and sulfasalazine.
Other common supplements include glucosamine and chondroitin
and bovine collagen.
There is one small published case series
that reports improved plaque psoriasis
after taking chondroitin supplements.
There is no specific study in psoriatic arthritis;
however, we know from the osteoarthritis literature
that this has proven benefit,
especially with patients with knee OA
who are having moderate to severe pain.
Other substances such as bovine collagen,
which can be topical or oral,
have very limited scientific backing.
There has been
some very serious allergic reactions reported.
A word of caution about other potentially used
herbs and supplements.
St. John's wort.
Historically this has been used to treat depression,
anxiety, sleep disorders, and nerve pain.
However, there is potential drug interactions
with immunosuppressant medications
such as cyclosporine, which is commonly used in psoriasis.
Ginseng, particularly in Asian patients,
ginseng may alter the ability of the body
to metabolize certain drugs.
Examples of these drugs include tacrolimus and colchicine,
other drugs that are commonly used
in the rheumatology division.
So in conclusion, remember herbs and supplements,
which are tried by nearly 50% of patients
with psoriasis and psoriatic arthritis,
are not bound by proven quality standards
that all prescription medications approved by the FDA have.
Herbs and supplements may still contain
very powerful ingredients that can alter your immune system
and the way your body processes medications.
Natural substances do not necessarily mean safer substances
or substances with less side effects.
We are here to help and are open to discussing
all of the herbs and supplements that you may be taking
or are interested in.
Complementary therapy should never be used
in place of your prescription medications.
It is also important for us
to know about the herbs and supplements you may take
because they may interact with your prescribed medications.
Please talk to your doctor about questions or concerns
that you may have regarding alternative therapies.
A great resource for specific information
on any herb or supplement can be found
at the National Center
for Complimentary and Integrative Health.
(uplifting music)