medwireNews: Weight-loss treatment that includes a very low energy liquid diet (VLED) can lead to long-term improvements in disease activity, function, and markers of the metabolic syndrome (MetS) in patients with psoriatic arthritis (PsA) and obesity, research shows.
Eva Klingberg (University of Gothenburg, Sweden) and colleagues say their findings “support the hypothesis of obesity as a promotor of disease activity in PsA, showing what could be attained by adding a weight loss program to routine medical care in patients with PsA and obesity.”
The researchers have previously shown that weight-loss treatment with a VLED (640 kcal/day) for 12 to 16 weeks, followed by a structured reintroduction of an energy-restricted diet, resulted in a median weight loss of 18.6% at 6 months in 41 patients with PsA and obesity (BMI ≥33 kg/m2). Furthermore, the weight loss was associated with significant improvements in disease activity in the joints, entheses, and skin.
In the current long-term follow-up, Klingberg and team report that median weight loss from baseline was 16.0% in the 39 participants assessed at 12 months and 7.4% in the 35 assessed at 24 months.
At 12 months, the majority (77.0%) of patients had a weight loss of at least 10% versus baseline, and a further 17.9% had weight loss of 5–10%. At 24 months, the corresponding proportions were 40.0% and 37.1%.
In terms of disease activity, median swollen/66 and tender/68 joint counts, extent of psoriasis by body surface area, Leeds enthesitis index, C-reactive protein (CRP) levels, VAS for global health and fatigue, and HAQ, BASFI, DAS28-CRP, and Disease Activity in PSoriatic Arthritis (DAPSA) scores were all significantly lower at 12 months than at baseline.
At 24 months, median swollen and tender joint counts, Leeds enthesitis index, CRP, HAQ, DAS28-CRP, and DAPSA scores remained significantly lower versus baseline.
At baseline, 28.2% of participants had minimal disease activity; this proportion increased significantly to 38.5% at 12 months and 45.7% at 24 months. However, there were no significant differences over time in VAS pain or Dermatology Life Quality Index scores.
Klingberg and team also looked at markers of MetS and found that, at 12 months, glycated hemoglobin, triglyceride (TG), and glucose levels were all significantly lower, and high-density lipoprotein (HDL) levels were significantly higher, than at baseline, with the differences in TG and HDL persisting to 24 months.
Furthermore, 76.9% of participants met the criteria for MetS at baseline, compared with just 38.5% and 60.0% at 12 and 24 months, respectively.
There were no significant differences in blood pressure between the study visits, but the investigators note that three patients stopped taking antihypertensive medication during the study, and two were able to halve their dose.
Writing in Arthritis Research & Therapy, Klingberg and co-authors conclude: “Given the difficulties to treat obesity in a longer perspective once it is established, more attention should be given to prevent weight gain and the development of obesity in patients with psoriasis and PsA.”
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Arthritis Res Ther 2020; 22: 254