Psoriatic arthropathy is a chronic inflammatory disease of the musculoskeletal system associated with psoriasis, which affects 1-2 people per 1,000 adults. It is a multifaceted disease characterized by various combinations of peripheral arthritis, dactylitis, spondylitis and enthesitis. At the same time, musculoskeletal manifestations can be combined with non-articular pathology involving the skin, nails, mucous membranes and internal organs. The purpose of the study was to evaluate the world experience of rehabilitation of motor disorders in patients with psoriatic arthropathy with comorbid conditions and to develop the most promising tasks of physical therapy. Materials and methods. To achieve this purpose, an analysis of literature sources in modern databases was conducted: Google Scholar, RSCI, Web of Science, Scopus, PubMed, Medline, Cochrane Central Register of Controlled Trials. Depth of search is 20 years (from January 2002 to November 2021). Results and discussion. Diagnosis of psoriatic arthropathy is relatively normal. However, taking into account all manifestations of psoriatic arthropathy remains a difficult task in practice. The development of key features of the disease for the possibility of forming a prognosis of rehabilitation and restoring the maximum functioning of the patient remains a particularly important and unsolved task. Despite significant advances in pharmacological treatment in recent years, the effectiveness of rehabilitation of patients with psoriasis, in particular with the clinical manifestation of psoriatic arthropathy, is always limited. Inadequate therapy or tolerance to existing psoriatic arthropathy therapy leads to limited joint mobility, reduced ability to perform daily activities, including walking, and, as a consequence, reduced quality of life. In addition, psoriatic arthropathy is often combined with comorbid pathology, which adversely affects the course of the underlying disease, complicates the choice of therapeutic agents, worsens the prognosis and reduces the life expectancy of patients. Conclusion. Given the significant prevalence, chronic recurrent nature of psoriatic arthropathy, progression of arthropathy with subsequent development of limited joint mobility, frequent combination of psoriatic arthropathy with comorbid pathology significantly reduce the effectiveness of treatment and quality of patients’ life. This requires the development and scientific substantiation of new rehabilitation programs

Keywords: physical therapy, psoriatic arthropathies, comorbid pathology

Full text: PDF (Ukr) 273K

1. Ocampo DV, Gladman D. Psoriatic arthritis. F1000Res. 2019;8:F1000 Faculty Rev-1665. PMID: 31583079. PMCID: PMC6758836. https://doi.org/10.12688/f1000research.19144.1
2. Lubrano E, Scriffignano S, Perrotta FM. Multimorbidity and comorbidity in psoriatic arthritis - a perspective. Expert Rev ClinImmunol. 2020 Oct;16(10):963-972. PMID: 32940114. https://doi.org/10.1080/1744666X.2021.1825941
3. Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med. 2017;376:2095-6. https://doi.org/10.1056/NEJMra1505557
4. Raychaudhuri SP, Wilken R, Sukhov AC, Raychaudhuri SK, Maverakis E. Management of psoriatic arthritis: Early diagnosis, monitoring of disease severity and cutting edge therapies. J Autoimmun. 2017;76:21-37. PMID: 27836567. https://doi.org/10.1016/j.jaut.2016.10.009
5. Roodenrijs NMT, Hamar A, Kedves M, Nagy G, van Laar JM, van der Heijde D, et al. Pharmacological and nonpharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis. RMD Open. 2021;7:e001512. PMID: 33419871. PMCID: PMC7798678. https://doi.org/10.1136/rmdopen-2020-001512
6. Perrotta FM, Scriffignano S, Benfaremo D, Ronga M, Luchetti MM, Lubrano E. New Insights in Physical Therapy and Rehabilitation in Psoriatic Arthritis: A Review. Rheumatol Ther. 2021;8(2):639-649. PMID: 33710586. PMCID: PMC8217348. https://doi.org/10.1007/s40744-021-00298-9
7. Dougados M. Comorbidities in rheumatoid arthritis. Curr Opin Rheumatol. 2016;28:282-288. Moltó A, Nikiphorou E. Comorbidities in spondyloarthritis. Front Med. 2018;12(5):62. PMID: 27027814. https://doi.org/10.1097/BOR.0000000000000267
8. Coates LC, Orbai AM, Azevedo VF, Cappelleri JC, Steinberg K, Lippe R, et al. Results of a global, patient-based survey assessing the impact of psoriatic arthritis discussed in the context of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire. Health Qual Life Outcomes. 2020;18(1):173. PMID: 32513190. . PMCID: PMC7282161. https://doi.org/10.1186/s12955-020-01422-z
9. Talotta R, Atzeni F, Sarzi-Puttini P, Masala IF. Psoriatic arthritis: From pathogenesis to pharmacologic management. Pharmacol Res. 2019;148:104394. PMID: 31505253. https://doi.org/10.1016/j.phrs.2019.104394
10. McGonagle D, Aydin SZ, Tan AL. The synovio-entheseal complex and its role in tendon and capsular associated inflammation. J Rheumatol Suppl. 2012;89:11-4. PMID: 22751582. https://doi.org/10.3899/jrheum.120233
11. Tillett W, Costa L, Jadon D, Wallis D, Cavill C, McHugh J, et al. The classification for psoriatic arthritis (CASPAR) criteria - a retrospective feasibility, sensitivity, and specificity study. J Rheumatol. 2012;39(1):154-6. PMID: 22089469. https://doi.org/10.3899/jrheum.110845
12. Gossec L, Baraliakos X, Kerschbaumer A, Wit M, McInnes I, Dougados M, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020;79:700-712. PMID: 32434812. PMCID: PMC7286048. https://doi.org/10.1136/annrheumdis-2020-217159
13. Orbai A-M, de Wit M, Mease P, Shea JA, Gossec L, Leung YY, et al. International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials. Ann Rheum Dis. 2017;76:673-80. PMID: 27613807. PMCID: PMC5344772. https://doi.org/10.1136/annrheumdis-2016-210242
14. Singh JA, Guyatt G, Ogdie A, Gladman DD, Deal C, Deodhar A, et al. Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Care Res (Hoboken). 2019;71(1):2-29. PMID: 30499259. PMCID: PMC8265826. https://doi.org/10.1002/acr.23789
15. Bavière W, Deprez X, Houvenagel E, Philippe P, Deken V, Flipo RM, et al. Association between comorbidities and quality of life in psoriatic arthritis: results from a multicentric crosssectional study. J Rheumatol. 2020;47:369-376. PMID: 31203223. https://doi.org/10.3899/jrheum.181471
16. Halvorsen S, Vøllestad NK, Provan SA, Semb AG, van der Heijde D, Hagen KB, et al. Cardiorespiratory fitness and cardiovascular risk in patients with ankylosing spondylitis: a Cross-Sectional comparative study. Arthritis Care Res. 2013;65:969-76. PMID: 23281265. PMCID: PMC3619024. https://doi.org/10.1002/acr.21926
17. Thomsen RS, Nilsen TI, Haugeberg G, Gulati AM, Kavanaugh A, Hoff M. Adiposity and physical activity as risk factors for developing psoriatic arthritis. Longitudinal data from the HUNT study. Arthritis Care Res (Hoboken). 2021;73(3):432-41. https://doi.org/10.1002/acr.24121
18. Di Minno MN, Peluso R, Iervolino S, Russolillo A, Lupoli R, Scarpa R, et al. Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor α blockers. Ann Rheum Dis. 2014;73:1157-62. PMID: 23771989. PMCID: PMC4033114. https://doi.org/10.1136/annrheumdis-2012-202812
19. Ko SH, Chi CC, Yeh ML, Wang SH, Tsai YS, Hsu MY. Lifestyle changes for treating psoriasis. Cochrane Database Syst Rev. 2019;7(7):CD011972. PMID: 31309536. PMCID: PMC6629583. https://doi.org/10.1002/14651858.CD011972.pub2
20. Naldi L, Conti A, Cazzaniga S, Patrizi A, Pazzaglia M, Lanzoni A, et al. Diet and physical exercise in psoriasis: a randomized controlled trial. Br J Dermatol. 2014;170(3):634-42. PMID: 24641585. https://doi.org/10.1111/bjd.12735
21. Myers J, Kokkinos P, Nyelin E. Physical activity, cardiorespiratory fitness, and the metabolic syndrome. Nutrients. 2019;11(7):1652. PMID: 31331009. PMCID: PMC6683051. https://doi.org/10.3390/nu11071652
22. Konerman MA, Walden P, Joseph M, Jackson EA, Lok AS, Rubenfire M. Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2019;49(3):296-307. PMID: 30561027. https://doi.org/10.1111/apt.15063
23. Porta S, Otero-Losada M, Kölliker Frers RA, Cosentino V, Kerzberg E, Capani F. Adipokines, Cardiovascular Risk, and Therapeutic Management in Obesity and Psoriatic Arthritis. Front Immunol. 2021;11:590749. PMID: 33643281. PMCID: PMC7902722. https://doi.org/10.3389/fimmu.2020.590749
24. Kolliker Frers RA, Cosentino V, Tau J, Kerzberg EM, Urdapilleta A, Chiocconi M, et al. Immune-Mediated Inflammation Promotes Subclinical Atherosclerosis in Recent-Onset Psoriatic Arthritis Patients without Conventional Cardiovascular Risk Factors. Front Immunol. 2018;9:139. PMID: 29535705. PMCID: PMC5834432. https://doi.org/10.3389/fimmu.2018.00139
25. Sveaas SH, Smedslund G, Hagen KB, Dagfinrud H. Effect of cardiorespiratory and strength exercises on disease activity in patients with inflammatory rheumatic diseases: a systematic review and meta-analysis. Br J Sports Med. 2017;51(14):1065-1072. PMID: 28455366. https://doi.org/10.1136/bjsports-2016-097149
26. Alemo Munters L, Dastmalchi M, Andgren V, Emilson C, Bergegård J, Regardt M, et al. Improvement in health and possible reduction in disease activity using endurance exercise in patients with established polymyositis and dermatomyositis: a multicenter randomized controlled trial with a 1-year open extension followup. Arthritis Care Res. 2013;65:1959-68. PMID: 23861241. https://doi.org/10.1002/acr.22068
27. Li YF, Jiang LJ, Tao Y, Qin GL, Li Z, He W. The effects of walking exercise combined with continuous health education on prevention of psoriasis recurrence. J Nurs Adm. 2015;15(4):294-296.
28. Rausch Osthoff AK, Niedermann K, Braun J, Adams J, Brodin N, Dagfinrud H, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018;77(9):1251-1260. PMID: 29997112. https://doi.org/10.1136/annrheumdis-2018-213585
29. Jensen P, Skov L. Psoriasis and Obesity. Dermatology. 2016;232(6):633-9. PMID: 28226326. https://doi.org/10.1159/000455840
30. Lemmey AB, Marcora SM, Chester K, Wilson S, Casanova F, Maddison PJ. Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum. 2009;61:1726-34. PMID: 19950325. https://doi.org/10.1002/art.24891
31. Roger-Silva D, Natour J, Moreira E, Jennings F. A resistance exercise program improves functional capacity of patients with psoriatic arthritis: a randomized controlled trial. Clin Rheumatol. 2018;37(2):389-95. https://doi.org/10.1007/ s10067-017-3917-x. PMID: 29185133. https://doi.org/10.1007/s10067-017-3917-x
32. Mahmood F, Coates LC, Helliwell PS. Current concepts and unmet needs in psoriatic arthritis. Clin Rheumatol. 2018;37(2):297-305. PMID: 29134513. https://doi.org/10.1007/s10067-017-3908-y
33. Kavuncu V, Evcik D. Physiotherapy in rheumatoid arthritis. Med Gen Med. 2004;6(2):3.
34. Stewart TJ, Tong W, Whitfeld MJ. The associations between psychological stress and psoriasis: a systematic review. Int J Dermatol. 2018;57(11):1275-82. PMID: 29516474. https://doi.org/10.1111/ijd.13956
35. Cozzi F, Ciprian L, Carrara M, Galozzi P, Zanatta E, Scanu A, et al. Balneotherapy in chronic inflammatory rheumatic diseases - a narrative review. Int J Biometeorol. 2018;62(12):2065-71. PMID: 30276474. https://doi.org/10.1007/s00484-018-1618-z
36. Millner JR, Barron JS, Beinke KM, et al. Exercise for ankylosing spondylitis: an evidence-based consensus statement. Semin Arthritis Rheum. 2016;45:411-27. PMID: 26493464. https://doi.org/10.1016/j.semarthrit.2015.08.003
37. Grinnell-Merrick LL, Lydon EJ, Mixon AM, Saalfeld W. Evaluating Inflammatory Versus Mechanical Back Pain in Individuals with Psoriatic Arthritis: A Review of the Literature. Rheumatol Ther. 2020;7(4):667-684. PMID: 32935330. PMCID: PMC7695767. https://doi.org/10.1007/s40744-020-00234-3
38. Kessler J, Chouk M, Ruban T, Prati C, Wendling D, Verhoeven F. Psoriatic arthritis and physical activity: a systematic review. Clin Rheumatol. 2021;40(11):4379-4389. PMID: 33913069. https://doi.org/10.1007/s10067-021-05739-y
39. Sunar I, Ataman S, Nas K, Kilic E, Sargin B, Kasman SA, et al. Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: a multi-center study. Rheumatol Int. 2020;40(2):283-294. PMID: 31773391. https://doi.org/10.1007/s00296-019-04480-9
40. Kaeley GS, Eder L, Aydin SZ, Gutierrez M, Bakewell C. Enthesitis: a hallmark of psoriatic arthritis. Semin Arthritis Rheum. 2018;48(1):35-43. PMID: 29429762. https://doi.org/10.1016/j.semarthrit.2017.12.008
41. Gracey E, Burssens A, Cambré I, Schett G, Lories R, McInnes IB, et al. Tendon and ligament mechanical loading in the pathogenesis of inflammatory arthritis. Nat Rev Rheumatol. 2020;16(4):193-207. PMID: 32080619. PMCID: PMC7815340. https://doi.org/10.1038/s41584-019-0364-x
42. Mayer F, Hirschmuller A, Muller S, et al. Effects of short-term treatment strategies over 4 weeks in Achilles tendinopathy. Br J Sports Med. 2007;41:e6. PMID: 17261560. PMCID: PMC2465365. https://doi.org/10.1136/bjsm.2006.031732
43. de Vos RJ, Weir A, Visser RJ, de Winter T, Tol JL. The additional value of a night splint to eccentric exercises in chronic midportion Achilles tendinopathy: a randomised controlled trial. Br J Sports Med. 2007;41: e5. PMID: 17178774. PMCID: PMC2465339. https://doi.org/10.1136/bjsm.2006.032532
44. Ordahan B, Turkoglu G, Karahan AY, Akkurt HE. Extracorporeal shockwave therapy versus kinesiology taping in the management of plantar fasciitis: a randomized clinical trial. Arch Rheumatol. 2017;32(3):227-33. PMID: 30375530. PMCID: PMC6190955. https://doi.org/10.5606/ArchRheumatol.2017.6059
45. Armagan Alpturker K, Cerrahoglu ABL, Orguc IS. Evaluation effects of laser therapy and extracorporeal shock wave therapy with clinical parameters and magnetic resonance imaging for treatment of plantar fasciitis in patients with spondyloarthritis: a randomized controlled trial. Int J Rheumatol. 2020;2020:4386361. PMID: 32908536. PMCID: PMC7474377. https://doi.org/10.1155/2020/4386361
46. Nelson NL, Churilla JR. Massage Therapy for Pain and Function in Patients With Arthritis: A Systematic Review of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017;96(9):665-672. PMID: 28177937. https://doi.org/10.1097/PHM.0000000000000712
47. Sung SH, Kim D, Park M, Hwang SI, Yoon YJ, Park JK, et al. Electroacupuncture for Temporomandibular Disorders: A Systematic Review of Randomized Controlled Trials. Healthcare (Basel). 2021;9(11):1497. PMID: 34828543. PMCID: PMC8624061. https://doi.org/10.3390/healthcare9111497
48. Gupta S, Syrimi Z, Hughes DM, Zhao SS. Comorbidities in psoriatic arthritis: a systematic review and meta-analysis. Rheumatol Int. 2021;41(2):275-284. PMID: 33423070. PMCID: PMC7835184. https://doi.org/10.1007/s00296-020-04775-2
49. Fernández-Carballido C, Martín-Martínez MA, García-Gómez C, Castañeda S, González-Juanatey C, Sánchez-Alonso F et al. Impact of comorbidity on physical function in patients with ankylosing spondylitis and psoriatic arthritis attending rheumatology clinics: results from a cross-sectional study. Arthritis Care Res. 2020;72:822-828. PMID: 31033231. PMCID: PMC7318148. https://doi.org/10.1002/acr.23910
50. Caiazzo G, Fabbrocini G, Di Caprio R, Raimondo A, Scala E, Balato N, et al. Psoriasis, Cardiovascular Events, and Biologics: Lights and Shadows. Front Immunol. 2018;9:1668. PMID: 30150978. PMCID: PMC6099159. https://doi.org/10.3389/fimmu.2018.01668
51. Jafri K, Bartels CM, Shin D, Gelfand JM, Ogdie A. Incidence and management of cardiovascular risk factors in psoriatic arthritis and rheumatoid arthritis: a population-based study: cardiovascular risk factors in PsA and RA. Arthritis Care Res. 2017;69:51-57. PMID: 27696731. PMCID: PMC5191972. https://doi.org/10.1002/acr.23094
52. Hansildaar R, Vedder D, Baniaamam M, Tausche AK, Gerritsen M, Nurmohamed MT. Cardiovascular risk in inflammatory arthritis: rheumatoid arthritis and gout. Lancet Rheumatol. 2021;3(1):e58-e70. https://doi.org/10.1016/S2665-9913(20)30221-6
53. Polachek A, Touma Z, Anderson M, et al. Risk of cardiovascular morbidity in patients with psoriatic arthritis: a meta-analysis of observational studies. Arthritis Care Res. 2017;69(67):74. PMID: 27111228. https://doi.org/10.1002/acr.22926
54. Sukhov A, Adamopoulos IE, Maverakis E: Interactions of the Immune System with Skin and Bone Tissue in Psoriatic Arthritis: A Comprehensive Review. Clin Rev Allergy Immunol. 2016;51(1):87-99. PMID: 26780035. PMCID: PMC6080719. https://doi.org/10.1007/s12016-016-8529-8
55. Zhao SS, Miller N, Harrison N, Dufeld SJ, Dey M, Goodson NJ. Systematic review of mental health comorbidities in psoriatic arthritis. Clin Rheumatol. 2020;39:217-225. PMID: 31486931. https://doi.org/10.1007/s10067-019-04734-8