Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study
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...
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| Format: | Article |
| Language: | English |
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BMC
2019-01-01
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| Series: | Arthritis Research & Therapy |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13075-019-1810-5 |
| _version_ | 1828748863439110144 |
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| author | Eva Klingberg Annelie Bilberg Sofia Björkman Martin Hedberg Lennart Jacobsson Helena Forsblad-d’Elia Hans Carlsten Björn Eliasson Ingrid Larsson |
| author_facet | Eva Klingberg Annelie Bilberg Sofia Björkman Martin Hedberg Lennart Jacobsson Helena Forsblad-d’Elia Hans Carlsten Björn Eliasson Ingrid Larsson |
| author_sort | Eva Klingberg |
| collection | DOAJ |
| description | 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 |
| first_indexed | 2024-12-10T05:36:37Z |
| format | Article |
| id | doaj.art-016201a1d088477b80e577992f71ca64 |
| institution | Directory Open Access Journal |
| issn | 1478-6362 |
| language | English |
| last_indexed | 2024-12-10T05:36:37Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Arthritis Research & Therapy |
| spelling | doaj.art-016201a1d088477b80e577992f71ca642022-12-22T02:00:24ZengBMCArthritis Research & Therapy1478-63622019-01-0121111010.1186/s13075-019-1810-5Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional studyEva Klingberg0Annelie Bilberg1Sofia Björkman2Martin Hedberg3Lennart Jacobsson4Helena Forsblad-d’Elia5Hans Carlsten6Björn Eliasson7Ingrid Larsson8Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of GothenburgInstitute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy at the University of GothenburgDepartment of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Institute of Medicine, Sahlgrenska Academy at University of GothenburgDepartment of Rheumatology, Hospital of BoråsDepartment of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of GothenburgDepartment of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of GothenburgDepartment of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of GothenburgDepartment of Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of GothenburgDepartment of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Institute of Medicine, Sahlgrenska Academy at University of GothenburgAbstract 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 registeredhttp://link.springer.com/article/10.1186/s13075-019-1810-5Psoriatic arthritisPsoriasisObesityMetabolic syndromeWeight lossVLED |
| spellingShingle | Eva Klingberg Annelie Bilberg Sofia Björkman Martin Hedberg Lennart Jacobsson Helena Forsblad-d’Elia Hans Carlsten Björn Eliasson Ingrid Larsson Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study Arthritis Research & Therapy Psoriatic arthritis Psoriasis Obesity Metabolic syndrome Weight loss VLED |
| title | Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study |
| title_full | Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study |
| title_fullStr | Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study |
| title_full_unstemmed | Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study |
| title_short | Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study |
| title_sort | weight loss improves disease activity in patients with psoriatic arthritis and obesity an interventional study |
| topic | Psoriatic arthritis Psoriasis Obesity Metabolic syndrome Weight loss VLED |
| url | http://link.springer.com/article/10.1186/s13075-019-1810-5 |
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