Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study

Abstract

BackgroundObesity is over-represented in patients with psoriatic arthritis (PsA) and associated with higher disease activity, poorer effect of treatment and increased cardiovascular morbidity. Studies on the effects of weight loss are however needed. This study aimed to prospectively study the effects of weight loss treatment with very low energy diet (VLED) on disease activity in patients with PsA (CASPAR criteria) and obesity (body mass index BMI ≥ 33 kg/m2).MethodsVLED (640 kcal/day) was taken during 12–16 weeks, depending on pre-treatment BMI. Afterwards, an energy-restricted diet was gradually reintroduced. Weight loss treatment was given within a structured framework for support and medical follow-up.Treatment with conventional synthetic and/or biologic disease-modifying anti-rheumatic drugs was held constant from 3 months before, until 6 months after baseline.Patients were assessed with BMI, 66/68 joints count, Leeds enthesitis index, psoriasis body surface area (BSA), questionnaires and CRP at baseline, 3 and 6 months. Primary outcome was the percentage of patients reaching minimal disease activity (MDA) and secondary outcomes were reaching Psoriatic Arthritis Response Criteria (PsARC) and American College of Rheumatology (ACR) response criteria.ResultsTotally 41/46 patients completed the study, 63% women, median age 54 years (IQR 48–62). At baseline increased BMI was associated with higher disease activity and poorer function.The median weight loss was 18.7 kg (IQR 14.6–26.5) or 18.6% (IQR 14.7–26.3) of the baseline weight. A majority of the disease activity parameters improved significantly after weight loss, including 68/66 tender/swollen joints count, CRP, BSA, Leeds enthesitis index, HAQ and patient VAS for global health, pain and fatigue. A larger weight loss resulted in more improvement in a dose-response manner. The percentage of patients with MDA increased from 29 to 54%, (p = 0.002). PsARC was reached by 46.3%. The ACR 20, 50 and 70 responses were 51.2%, 34.1% and 7.3% respectively.ConclusionsShort-term weight loss treatment with VLED was associated with significant positive effects on disease activity in joints, entheses and skin in patients with PsA and obesity. The study supports the hypothesis of obesity as a promotor of disease activity in PsA.Trial registrationClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016—retrospectively registeredElectronic supplementary materialThe online version of this article (10.1186/s13075-019-1810-5) contains supplementary material, which is available to authorized users.

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

“…In the present study the weight loss treatment with VLED was judged as easy to implement by most PsA patients, but the transition from VLED to normal food was perceived as harder. [20] A substantial weight reduction was noted during the VLED treatment, but as expected the participants started to gain weight already at six months. The participants were given an energy-reduced dietary advice and were instructed to engage in health-enhancing physical activity at least 150 minutes per week, but no follow up was made between 12-and 24-month visits.…”

“…We have previously in an open interventional study shown that weight loss treatment with Very Low Energy Diet (VLED) in 41 patients with PsA and obesity resulted in a substantial weight loss of median 18.7 kg (interquartile range: IQR 14.6-26.5) after six months, which was associated with positive effects on the disease activity in joints, entheses and skin. [20] Signi cant improvements were noted regarding number of swollen and tender joints, enthesitis, extent of psoriasis, C-reactive protein (CRP), pain, fatigue and physical function at six months observation. The number of patients with Minimal Disease Activity (MDA) increased from 29% to 54% (p=0.002).…”

“…The number of patients with Minimal Disease Activity (MDA) increased from 29% to 54% (p=0.002). [20] Short term weight loss can however easily be regained. Moreover, the anti-in ammatory effects seen in our previous study could have been caused by, both metabolic effects due to energy restriction during the initial phase of rapid weight loss, as well as loss of adipose tissue and lessened production of proin ammatory cytokines and adipokines therein.…”

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“…The percentage of patients with MDA increased from 29% to 54%. 6 Epidemiological studies have provided robust evidence that obesity is a risk factor for incident psoriasis and PsA, aggravates existing psoriasis and PsA, interferes with treatment of those diseases and is associated with decreased drug survival of biologics in psoriasis. 7,8 Recently published Mendelian randomization studies have provided evidence that higher body mass index (BMI) causally increases the odds of psoriasis by 9% for each unit increase in BMI.…”

Significant weight loss improves and prevents psoriasis and psoriatic arthritis in obese patients: a Critically Appraised Topic and a call to action

“…In a recently published prospective cohort study, a 640 kcal per day diet for 12–16 weeks led to a median weight loss of 18·7 kg (18·6% of baseline weight) in 41 out of 46 patients with PsA who completed the study, and was associated with a significant improvement in most disease activity parameters in a dose‐dependent manner. The percentage of patients with MDA increased from 29% to 54% …”