Weight loss associated with improvement in psoriatic arthritis
Patients with psoriatic arthritis and obesity had lower disease activity with a very low energy liquid diet, according to a study published in Arthritis Research & Therapy.
“Obesity, diabetes, hypertension, hyperlipidemia and the metabolic syndrome are overrepresented in both psoriasis and PsA, and the patients are at increased risk of cardiovascular morbidity,” Eva Klingberg, MD, and colleagues wrote.
At baseline, 46 patients with PsA and 52 control subjects started the very low energy liquid diet (VLED).
“The VLED provides a mixture of carbohydrates, proteins and fats, with added recommended doses of vitamins, minerals, trace elements and essential fatty acids, in powder formulas that require mixing with hot or cold water before consumption as shakes or soups,” the authors wrote.
Participants took the VLED four times per day, for a daily intake of 640 kcal. Food was reintroduced gradually over 12 weeks, with subjects receiving individual dietary advice for weight stability.
Median weight loss at 12 months from baseline was 16.1% in 39 patients with PsA, and at 24 months from baseline, 7.4% in 35 patients.
Patients with minimal disease activity increased from 28.2% at baseline to 38.5% at 12 months and 45.7% at 24 months, showing a significant association with weight loss.
In addition, blood pressure, HbA1c and serum levels of total cholesterol, low-density lipoprotein, triglycerides and glucose were reduced significantly, with high-density lipoprotein increasing significantly, at the 6-month follow-up. HbA1c, triglycerides and glucose were still reduced at 12 months with higher high-density lipoprotein, and at 24 months, triglycerides were reduced with higher high-density lipoprotein.
“Weight loss treatment with VLED in patients with PsA and obesity was associated with sustained lowered disease activity after 12 months and 24 months of follow-up, with concurrent improvements in cardiovascular risk factors and lowered serum urate,” the authors wrote. “The results of the study provide support to the hypothesis of obesity as a promotor of disease activity in PsA and shows what can be achieved by 5% to 15% weight loss in patients with PsA and obesity.”