# Exercise as it relates to Disease/The effects of exercise on Psoriatic arthritis
## What is psoriatic arthritis?

Psoriatic arthritis (PsA) is a condition that causes chronic inflammation of the joints. This causes the joints to become painful, stiff, often swollen and restrict the movement of the joints. Usually only people who have a skin disease called psoriasis are affected by psoriatic arthritis. Only one or two out of every 10 people with psoriasis will develop this type of arthritis.
Psoriatic arthritis of a mild form is sometimes referred to as oligoarticular, meaning it affects four or fewer joints in the body. Others may have a more severe polyarticular form (affecting four or more joints).

## Types

There are 3 types of psoriatic arthritis.

### Spondylitis

Spondylitis is inflammation of the spinal column. The main symptoms are inflammation with stiffness of the neck, lower back and sacroiliac joints. Spinal arthritis makes joint motion in these areas painful and difficult.

### Enthesitis

Enthesitis refers to inflammation of entheses, the site where ligaments or tendons insert into the bones. Common locations for enthesitis include the bottoms of the feet, the Achilles' tendons, and the places where ligaments attach to the ribs, spine, and pelvis.

### Dactylitis

Dactylitis, or "sausage digits," refers to inflammation/swelling of an entire finger or toe. It occurs due to inflammation of the small joints and enthesitis of the surrounding tendons.

## Symptoms

Psoriatic arthritis can affect any joint in the body and symptoms can vary from person to person. It can develop slowly with mild symptoms, or come on quickly and be severe. The most common symptoms are:
* pain, swelling and stiffness in one or more joints
* pain and stiffness in the buttocks, lower back or neck
* pain in tendons, such as at the back of the heel or sole of the foot
* changes in nails, such as thickening, colour change or separation from the skin
* pain and redness in the eyes.

## Causes

Psoriatic arthritis occurs when your body's immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as overproduction of skin cells. It is still unclear to why this happens. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis.

## Treatment

Treatment for psoriatic arthritis can relieve pain, reduce swelling, help keep joints working properly and possibly prevent further joint damage. However there is no cure to prevent psoriatic arthritis. Treatments include:
* Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
* Disease-Modifying Antirheumatic Drugs (DMARDs)
* Biologics (biologic drugs)
* Oral treatment drugs
* Other treatments such as exercise

## Why exercise and the effects of exercise

Physical activity is one of the most effective non-medical treatments of the management of psoriatic arthritis.
Exercise can:
* help to reduce pain and fatigue
* strengthen the muscles
* improve mobility and flexibility of the joints
* improve posture and balance
* reduce muscle tension and stress
Flexibility and muscle strengthening are very important components. Flexibility can improve or maintain mobility of the joints and muscles. Strengthening the muscles can help to decrease the load or pressure from sore joints, strengthen bones and improve balance.
Regular 30 minute moderate exercise a day is recommended for psoriatic arthritis treatment. It is recommended that during "flare" (period of increased stiffness and pain) patient should have more rest.
If a patient is experiencing pain from psoriatic arthritis, it is recommended to exercise in water. The water's buoyancy can prevent patients from putting stress on hips, knees and spine but allow to build strength.

## Recommended exercise guidelines

* Always build up slowly. When you first start, do less than you think you will be able to manage. If you cope well, do a little bit more next time and keep building up gradually.
* Always start your exercise with some gentle movements to warm up your body and your joints. This can help prevent pain and injury during exercise.
* Cool down at the end of your session with some gentle movements and stretches. This can help prevent muscle pain and stiffness the next day.
* Avoid activities involving prolonged walking or standing
Choose low-impact exercises, with less weight or force going through your joints. Examples of some of the activities with low impact:
* Walking
* Exercises in water (e.g. hydrotherapy or swimming classes)
* Tai Chi
* Yoga
* Pilates
* Cycling
* Dancing

## References

* ↑ Gottlieb A, Korman NJ, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008; 58:851–64.
* ↑ Friberg C. Genetic studies of psoriasis and psoriatic arthritis, Goteborg University, Sweden 2007.
* ↑ Kjeken I, Dagfinrud H, Mowinckel P, Uhlig T, Kvien TK, Finset A. Rheumatology care: involvement in medical decisions, received information, satisfaction with care, and unmet health care needs in patients with rheumatoid arthritis and ankylosing spondylitis. Arthritis Rheum. 2006;55:394– 401.