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. 2019 Jan 11;21(1):17.
doi: 10.1186/s13075-019-1810-5.

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

Eva Klingberg  1 , Annelie Bilberg  2 , Sofia Björkman  3 , Martin Hedberg  4 , Lennart Jacobsson  5 , Helena Forsblad-d'Elia  5   6 , Hans Carlsten  5 , Björn Eliasson  7 , Ingrid Larsson  3
Affiliations

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

Eva Klingberg et al. Arthritis Res Ther. .

Abstract

Background: Obesity 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).

Methods: VLED (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.

Results: Totally 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.

Conclusions: Short-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 registration: ClinicalTrials.gov identifier: NCT02917434 , registered on September 21, 2016-retrospectively registered.

Keywords: Cardiovascular disease; Metabolic syndrome; Obesity; Psoriasis; Psoriatic arthritis; VLED; Weight loss.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Regional Ethics Committee in Gothenburg and carried out in accordance with the Helsinki declaration. All participants gave their written informed consent.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no financial or nonfinancial competing interests. The patients were able to buy the VLED at a reduced price from Cambridge Weight Plan Limited, Solna, Sweden.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The percentage of patients reaching American College of Rheumatology (ACR) 20, ACR 50 and ACR 70 response criteria, Psoriatic Arthritis Response Criteria (PsARC) and Minimal Disease Activity (MDA). BL, baseline; M6, 6 months visit
Fig. 2
Fig. 2
Boxplots showing the distributions at baseline and the 3 and 6 months visits of a psoriatic body surface area (BSA), b Disease Activity in PSoriatic Arthritis (DAPSA), c Disease Activity Score using 28 joint counts based on CRP (DAS28CRP) and d Health Assessment Questionnaire (HAQ)
Fig. 3
Fig. 3
The patients’ experience of the very low energy diet (VLED) treatment and the transition from VLED to normal food
See this image and copyright information in PMC

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