Impact of physical therapy rehabilitation on Quality of Life in Patients with psoriatic arthritis
DOI:
https://doi.org/10.5281/zenodo.22813955Keywords:
psoriatic arthritis, physical therapy, rehabilitation, quality of life, exercise therapyAbstract
Background: Psoriatic arthritis (PsA) affects up to 30% of people with psoriasis, and its combination of synovitis, enthesitis, dactylitis, axial disease and skin involvement burdens physical function and quality of life (QoL) in ways pharmacologic treatment alone often leaves incompletely addressed.
Objective: This review synthesizes evidence on structured physical therapy and exercise-based rehabilitation as an adjunct to pharmacologic PsA management, focusing on patient-reported quality of life, function, pain and fatigue.
Methods: We synthesized randomized trials, systematic reviews and cohort studies of supervised exercise, aquatic therapy, patient education and multidisciplinary rehabilitation in PsA, alongside related evidence from rheumatoid arthritis and axial spondyloarthritis where PsA-specific data are limited.
Findings: Combined aerobic-resistance exercise produces consistent, moderate improvements in functional and QoL scores relative to usual care, aquatic therapy reduces enthesitis-related pain, and multidisciplinary programs pairing physiotherapy with education and psychological support yield larger QoL gains than exercise alone; benefits are consistent but modest and depend on adherence.
Conclusions: Physical therapy rehabilitation is a safe, clinically meaningful adjunct to pharmacotherapy for improving quality of life in PsA and should be incorporated routinely into multidisciplinary care, though larger PsA-specific trials are needed to define optimal dose and modality.
References
Gladman, D.D., Antoni, C., Mease, P., Clegg, D.O., Nash, P. (2005) Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Annals of the Rheumatic Diseases, 64(Suppl
: ii14-ii17. 2. Ritchlin, C.T., Colbert, R.A., Gladman, D.D. (2017) Psoriatic arthritis. New England Journal of Medicine, 376(10): 957-970.
Ogdie, A., Weiss, P. (2015) The epidemiology of psoriatic arthritis. Rheumatic Disease Clinics of North America, 41(4): 545-568.
Mease, P.J., Gladman, D.D., Papp, K.A., Khraishi, M.M., Thaci, D., Behrens, F., et al. (2018) Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. Journal of the American Academy of Dermatology, 69(5): 729-735.
Husni, M.E., Merola, J.F., Davin, S. (2017) The psychosocial burden of psoriatic arthritis. Seminars in Arthritis and Rheumatism, 47(3): 351-360.
Gudu, T., Gossec, L. (2018) Quality of life in psoriatic arthritis. Expert Review of Clinical Immunology, 14(5): 405-417.
Rosen, C.F., Mussani, F., Chandran, V., Eder, L., Thavaneswaran, A., Gladman, D.D. (2012) Patients with psoriatic arthritis have worse quality of life than those with psoriasis alone. Rheumatology, 51(3): 571-576.
Gladman, D.D., Mease, P.J., Cifaldi, M.A., Perdok, R.J., Sasso, E. (2007) Adalimumab improves joint-related and skin-related functional impairment in patients with psoriatic arthritis. Annals of the Rheumatic Diseases, 66(2): 163-168.
Minnock, P., McKee, G., Kelly, A., Carter, S.C., Menke Van der Houven Van Oordt, C., Veale, D.J. (2016) Quality of life, fatigue and physical function in psoriatic arthritis. British Journal of Occupational Therapy, 79(9): 555-563.
Tillett, W., de-Vries, C., McHugh, N.J. (2013) Work disability in psoriatic arthritis: a systematic review. Rheumatology, 51(2): 275-283.
Ogdie, A., Schwartzman, S., Husni, M.E. (2018) Recognizing and managing comorbidities in psoriatic arthritis. Current Opinion in Rheumatology, 26(2): 118-123.
Coates, L.C., Kavanaugh, A., Mease, P.J., Soriano, E.R., Laura Acosta-Felquer, M., Armstrong, A.W., et al. (2016) Group for research and assessment of psoriasis and psoriatic arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis & Rheumatology, 68(5): 1060-1071.
Gossec, L., Baraliakos, X., Kerschbaumer, A., de Wit, M., McInnes, I., Dougados, M., et al. (2020) EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Annals of the Rheumatic Diseases, 79(6): 700-712.
FitzGerald, O., Ogdie, A., Chandran, V., Coates, L.C., Kavanaugh, A., Tillett, W., et al. (2021) Psoriatic arthritis. Nature Reviews Disease Primers, 7(1): 59.
Roubille, C., Richer, V., Starnino, T., McCourt, C., McFarlane, A., Fleming, P., et al. (2015) Evidence-based recommendations for the management of comorbidities in rheumatoid arthritis, psoriasis, and psoriatic arthritis. Annals of the Rheumatic Diseases, 74(3): 480-489.
Gwinnutt, J.M., Wieczorek, M., Balanescu, A., Bischoff-Ferrari, H.A., Boonen, A., Cavalli, G., et al. (2023) 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. Annals of the Rheumatic Diseases, 82(1): 48-56.
Cavalli, G., Caporali, R. (2019) Managing pain and function in psoriatic arthritis: the role of non-pharmacological therapy. Clinical and Experimental Rheumatology, 37(Suppl 108): S135-S141.
Hurkmans, E., van der Giesen, F.J., Vliet Vlieland, T.P., Schoones, J., Van den Ende, E.C. (2009) Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database of Systematic Reviews, (4): CD006853.
Brodin, N., Eurenius, E., Jensen, I., Nisell, R., Opava, C.H. (2008) Coaching patients with early rheumatoid arthritis to healthy physical activity. Physical Therapy, 88(9): 1042-1052.
Stavropoulos-Kalinoglou, A., Metsios, G.S., Koutedakis, Y., Kitas, G.D. (2009) Exercise as a therapeutic intervention in rheumatoid arthritis. Rheumatology, 48(9): 1005-1011.
Sveaas, S.H., Berg, I.J., Fongen, C., Provan, S.A., Michelsen, B., Hagen, K.B., et al. (2017) High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis. Annals of the Rheumatic Diseases, 76(2): 336-343.
Regnaux, J.P., Davergne, T., Palazzo, C., Roren, A., Rannou, F., Boutron, I., et al. (2019) Exercise programmes for ankylosing spondylitis. Cochrane Database of Systematic Reviews, (10): CD011321.
Cooksey, R., Choy, E. (2018) Exercise in psoriatic arthritis: current evidence and emerging concepts. RMD Open, 4(1): e000598.
Katz, P., Margaretten, M., Gregorich, S., Trupin, L. (2018) Physical activity to reduce fatigue in rheumatoid arthritis. Arthritis Care & Research, 70(1): 1-10.
Gunay, U., Gulcan, R.C., Karatepe, A.G. (2018) Effects of an aquatic exercise program on disease activity, functional capacity and quality of life in patients with ankylosing spondylitis. Turkish Journal of Physical Medicine and Rehabilitation, 64(4): 328-336.
Eppeland, S.G., Diamantopoulos, A.P., Soldal, D.M., Haugeberg, G. (2013) Short term in-patient rehabilitation in axial spondyloarthritis. BMC Musculoskeletal Disorders, 14: 10.
Marchesoni, A., De Lucia, O., Rotunno, L., De Marco, G., Manara, M. (2018) Entheseal power doppler ultrasonography: a comparison of psoriatic arthritis and fibromyalgia. Journal of Rheumatology, 45(Suppl 96): 23-25.
Helliwell, P.S. (2011) Exercise and other physiotherapy interventions in the management of psoriatic arthritis. Clinical and Experimental Rheumatology, 29(3 Suppl 65): S45-S47.
Oliver, K., Cronan, T. (2005) Predictors of exercise behaviors among fibromyalgia patients. Preventive Medicine, 35(4): 383-389.
Munsterhjelm, C., Nikiphorou, E., Ramiro, S. (2023) Multidisciplinary rehabilitation for people with inflammatory arthritis: a scoping review. RMD Open, 9(2): e003098.
Vliet Vlieland, T.P.M., van den Ende, C.H.M. (2011) Nonpharmacological treatment of rheumatoid arthritis. Current Opinion in Rheumatology, 23(3): 259-264.
Iversen, M.D., Frits, M., von Heideken, J., Shadick, N.A. (2010) Rehabilitation interventions for pain and disability in rheumatoid arthritis. Physical Therapy, 90(9): 1246-1258.
Turkiewicz, A.M., Moe, R.H., Uhlig, T., Garratt, A.M., Hagen, K.B. (2015) Physiotherapy and physical activity trends in inflammatory arthritis. Best Practice & Research Clinical Rheumatology, 29(1): 88-96.
Prior, Y., Bannister, M., Chisholm, A., Waddell, C., Helliwell, P. (2015) The importance of physiotherapy and occupational therapy in the management of psoriatic arthritis. Musculoskeletal Care, 13(4): 226-234.
Silva, K.N., Mizusaki Imoto, A., Almeida, G.J., Atallah, A.N., Peccin, M.S., Fernandes Moca Trevisani, V. (2010) Balance training (proprioceptive training) for patients with rheumatoid arthritis. Cochrane Database of Systematic Reviews, (5): CD007648.
Published
Issue
Section
License
Copyright (c) 2020 Nia Diallo, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.