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

Journal article
Authors Eva Klingberg
Annelie Bilberg
Sofia Björkman
M. Hedberg
Lennart T. H. Jacobsson
Helena Forsblad d'Elia
Hans Carlsten
Björn Eliasson
Ingrid Larsson
Published in Arthritis Res Ther
Volume 21
Issue 1
Pages 17
ISSN 1478-6354
Publication year 2019
Published at Institute of Medicine, Department of Rheumatology and Inflammation Research
Institute of Medicine
Pages 17
Language en
Links dx.doi.org/10.1186/s13075-019-1810-...
Keywords Psoriatic arthritis, Psoriasis, Obesity, Metabolic syndrome, Weight loss, VLED, Cardiovascular disease, adipose-tissue, metabolic syndrome, severity, risk, enthesitis, spondyloarthritis, inflammation, prevalence, adipokines, criteria, Rheumatology, evoo mll, 1995, arthritis and rheumatism, v38, p44
Subject categories Clinical Medicine

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 33kg/m(2)).MethodsVLED (640kcal/day) was taken during 12-16weeks, 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 3months before, until 6months 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 6months. 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 54years (IQR 48-62). At baseline increased BMI was associated with higher disease activity and poorer function.The median weight loss was 18.7kg (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, 2016retrospectively registered

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