Psoriatic arthritis is a chronic inflammatory condition that affects your joints and skin. The hallmark symptoms are joint pain, stiffness, swelling, and joint injury. This type of arthritis typically occurs in people with psoriasis, and the risk of developing psoriatic arthritis among them is about 30%.
Other risk factors include family history, age 30 to 50, obesity, and smoking.
Timely diagnosis and treatment can help prevent or delay joint damage. While massage therapy is not a cure of psoriatic arthritis, it can reduce the pain symptoms and improve quality of life.
Is it okay to get a massage?
According to the 2018 American College of Rheumatology/National Psoriasis Foundation (ACR/NOF) guidelines, massage can be helpful if you have psoriatic arthritis, but you should keep the following guidelines in mind.
You need to find a massage therapist who is knowledgeable about different types of arthritis so that you can be certain they use techniques that are less likely to aggravate your joints or worsen skin sensitivity. The massage therapist should stick to techniques like Swedish massage, lymphatic drainage,or myofascial release rather than deep tissue work.
You also need a massage therapist who is a good communicator—and be a good communicator yourself. The therapist will be better equipped to help you if you educate them on your tender points, joint pain, and/or areas of skin lesions.
The massage therapist may also want to know what medications you take to manage your condition. If you are taking immunosuppressants, you may have fragile skin or be more likely to develop bruising even with less aggressive techniques.
If you are in the midst of a flare up, it may be best to wait until the symptoms have subsided before having any bodywork done.
While massage provides mostly short-term relief, it can help reduce symptoms through several mechanisms:
- Descending modulation of pain: Massage can activate descending pathways in the central nervous system that allow for decreased pain perception through your body’s own opioid release.
- Increased circulation and lymphatic drainage: Lighter massage strokes, such as effleurage, can improve local blood flow, decrease stiffness, and promote healing.
- Overall relaxation: Therapeutic touch can decrease cortisol levels and increase the parasympathetic activity in the central nervous system leading to muscle relaxation and decreased stress levels which may, in turn, decrease pain.
- Gate control theory of pain: Your spine has a “pain gate” that controls how much pain reaches your brain. Light massage sends non-painful signals that can help close the gate so that the nociceptive signals can’t get through.
Early warning signs of psoriatic arthritis
Symptoms of psoriatic arthritis may be subtle when first developed. If you or anyone in your family have psoriasis and notice these changes, a medical evaluation is a good idea.
Some early warning signs include:
- Joint pain and stiffness that is worse in the morning or after a period of rest
- Swelling in the large joints, fingers, or toes
- Dactylitis or swelling in the fingers or toes that is described as “sausage-like”
- Changes to the appearance of your fingernails or toenails that may include pitting, ridges, discoloration, or changes to the nail bed
- Persistent fatigue in absence of any activity that makes you tired
- Pain at the attachment sites of ligaments or tendons (enthesitis)
Risk factors
Risk factors for psoriatic arthritis are a combination of biological and environmental factors.
Genetics
Family history is a significant predictor of the development of psoriatic arthritis. Just as in ankylosing spondylitis (another arthritic condition), the HLA-B27 gene has been linked to psoriatic arthritis and is associated with the immune system’s regulation and plays a role in the development of psoriatic arthritis. The gene can trigger an abnormal immune response that leads to joint inflammation, pain, and stiffness.
As many as 40% to 50% of those with psoriatic arthritis have the HLA-B27 gene.
Several other genes have also been identified as potential contributors. In those with psoriatic arthritis, certain immune-related genes can be overactive which causes the immune system to recruit more cells whose job is to respond to infection or injury. When these cells, called neutrophils, move to psoriatic skin lesions to “help” they can cause damage to otherwise healthy tissues.
Environmental factors
In people with a higher genetic risk, environmental factors like stress, obesity, or gut issues can trigger an immune response. These factors activate immune cell receptors, prompting them to release inflammatory signals that cause inflammation. The immune system sends cells to fight what it thinks is a threat. When the threat is real, this response helps restore health. But when the immune system mistakes healthy tissues for a threat, it starts attacking the body’s own tissues.
Infections
Infections also trigger the immune system to mount a response to the affected tissues. In people with psoriatic arthritis, Streptococcus bacteria has been found in the joints and blood making throat infections a potential risk factor for the development of psoriatic arthritis.
Obesity
Those with psoriatic arthritis are more likely to be obese for many reasons.
The most common include:
- Chronic inflammation leading to weight gain due to increased appetite or changes to your metabolism
- Joint pain and stiffness can make it difficult to stay active, leading to weight gain
- Medications used to treat the condition, such as corticosteroids, can cause you to gain weight
People with psoriatic arthritis who are obese have a higher risk of inflammation that worsens the condition. Extra fat releases substances that cause inflammation, which can increase the risk of developing psoriatic arthritis. Obesity also puts additional stress on the joints, leading to more inflammation. Maintaining a healthy weight may help reduce the risk of developing psoriatic arthritis and improve the management of the condition.
Biomechanical stress
Biomechanical stress, especially from obesity, increases pressure on the areas where tendons and ligaments attach to bones (entheses). This added stress can cause microdamage, leading to inflammation. In people with a genetic predisposition to psoriatic arthritis, this inflammation can trigger an immune response that attacks healthy tissue, increasing the risk of developing psoriatic arthritis. Reducing weight can help lessen the strain on joints and reduce the risk of psoriatic arthritis.
Can physical therapy help?
There are several ways physical therapy can help manage psoriatic arthritis. A customized physical therapy program helps manage psoriatic arthritis by improving mobility, reducing pain, and preventing joint damage.
Pain management techniques like manual or massage therapy, heat, cold, or TENS (electrical stimulation) can help with discomfort. Mobility and flexibility exercises prevent stiffness and maintain function. Low-impact resistance exercises improve strength and endurance.
Education on posture and body mechanics may reduce strain and fatigue, while balance training improves coordination and reduces the risk of falls. Energy conservation strategies help manage daily activities efficiently.
A consistent, low-impact exercise routine (e.g., swimming, cycling, yoga) is often recommended to maintain function without overloading the joints. A physical therapist can adjust the program based on symptom severity and flare-ups, ensuring safe and effective management of psoriatic arthritis.
Nick Ng is the editor of Massage & Fitness Magazine and the managing editor for My Neighborhood News Network.
An alumni from San Diego State University with a bachelor’s in graphic communications, Nick also completed his massage therapy training at International Professional School of Bodywork in San Diego in 2014. In 2021, he earned an associate degree in journalism at Palomar College.
When he gets a chance, he enjoys weightlifting at the gym, salsa dancing, and exploring new areas in the Puget Sound area in Washington state.
