Weight loss is associated with sustained improvement of disease activity and cardiovascular risk factors in patients with psoriatic arthritis and obesity: a prospective intervention study with two years of follow-up

Abstract

Background Obesity is overrepresented in patients with psoriatic arthritis (PsA) and associated with increased disease activity. We have previously shown in 41 patients with PsA (Caspar criteria) and obesity (body mass index; BMI ≥33 kg/m2) that weight loss treatment with Very Low Energy Liquid Diet (VLED), 640 kcal/day during 12–16 weeks, followed by a structured reintroduction of an energy restricted diet resulted in a median weight loss of 18.6% and concomitantly a significant improvement of the disease activity in joints, entheses and skin. The objectives of this follow-up were to study the effects of the weight loss treatment on disease activity in longer term (12 and 24 months) and to study the effects on cardiovascular risk factors. Methods The patients were assessed with 66/68 joints count, Leeds enthesitis index (LEI), body surface area, blood pressure, BMI, questionnaires and fasting blood samples at the 12- and 24-month visits. Results In total, 39 and 35 PsA patients attended the 12- and the 24-month visits, respectively. Median weight loss since baseline was 16.0% (IQR 10.5–22.4) and 7.4% (IQR 5.1–14.0) at the 12- and 24-months follow-up. The 66/68 swollen/tender joints score, LEI, CRP and HAQ score were still significantly reduced at the 12- and 24-month visits compared to baseline. The number of patients with Minimal Disease Activity increased from 28.2% (11/39) at baseline, to 38.5% (15/39; p = 0.008) and 45.7% (16/35; p = 0.016) at the 12- and 24-month visits. The weight loss was also associated with improved levels of serum lipids, glucose and urate and the antihypertensive treatment was reduced or stopped in five patients during the follow-up. Conclusions Weight loss treatment, with VLED included in the program, was associated with long-term improvement of measures of disease activity, self-reported function and markers of the metabolic syndrome after 24-months follow-up. Trial registration ClinicalTrials.gov identifier: NCT02917434, Registered September 28, 2016- Retrospectively registered.

Update on Cardiovascular Risk and Obesity in Psoriatic Arthritis

“…After two years follow up, some PsA patients regained weight, but disease activity outcomes were maintained, and the number of patients with minimal disease activity increased from 28.2% at baseline to 45.7% at 24 months. The weight loss was also associated with improved levels of serum lipids, glucose and urate and antihypertensive treatment was reduced or stopped in several patients during the follow up (52). These results support the findings of previous studies showing better responses to TNFi and greater odds of achieving minimal disease activity after a 5% weight loss (53).…”

The Link Between Obesity and the Skin

“…Obesity is an independent risk factor associated with psoriasis severity and response to systemic therapy (i.e., methotrexate, cyclosporine, apremilast, and biologic agents) (37)(38)(39). Finally, dietary interventions and weight loss improve the disease course and severity of comorbid psoriasis (40,41).…”

Comorbidity in Adult Psoriasis: Considerations for the Clinician

“…Lastly, studies have shown that dietary intervention and physical exercise may have a positive effect on the cardiovascular risk profile and the severity of psoriasis. 38 , 39 Improvement of the cardiovascular risk profile by dietary means is clinically relevant. In short, it is recommended to eat higher volumes of fruit, vegetables, fish, wholegrain and polyunsaturated fats (fish, nuts etc.).…”