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Diet and Weight Loss Improves Psoriatic Arthritis

Short-term intervention with the very low energy diet (VLED) in psoriatic arthritis (PsA) with obesity (body mass index BMI ≥ 33 kg/m2) showed that weight loss was associated with significant positive benefits on weight and disease activity in joints, entheses and skin. 

Obesity is highly prevalent in psoriatic patients and is associated with higher disease activity, poorer effect of treatment and increased cardiovascular morbidity. 

VLED (640 kcal/day) was taken during 12–16 weeks, depending on pre-treatment BMI. Afterwards, an energy-restricted diet was gradually reintroduced. 

A total of 46 patients were enrolled and maintained on static treatment with conventional and/or biologic disease-modifying anti-rheumatic drugs from 3 months before, until 6 months after, baseline. 

A total 46 patients were enrolled and 41 completed the study; increased BMI at baseline was associated with higher disease activity and poorer function.

The median weight loss in the trial was 18.7 kg (IQR 14.6–26.5) or 18.6% of the baseline weight.

Disease parameters improved significantly after weight loss, including tender/swollen joint counts, CRP, BSA, Leeds enthesitis index, HAQ and patient VAS for global health, pain and fatigue.

Weight loss was associated with an increase in minimal disease activity (MDA) from 29 to 54%, (p = 0.002).

ACR 20, 50 and 70 responses were 51.2%, 34.1% and 7.3% respectively, at 6 months follow-up. A larger weight loss resulted in more improvement in a dose-response manner. The treatment was effective, safe and well tolerated.

These findings were underscored by recent dietary recommendations from the National Psoriasis Foundation.(Citation https://buff.ly/2Noqidk and  https://buff.ly/2CfRkyw)

Disclosures: 
The author has received compensation as an advisor or consultant on this subject

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