The impact of a structured weight-loss treatment on physical fitness in patients with psoriatic arthritis and obesity compared to matched controls: a prospective interventional study

Weighing in on obesity and psoriatic arthritis - Time to move beyond association to robust randomised trials

Almost one in two individuals with psoriatic arthritis (PsA) are now living with obesity. Obesity increases the risk of developing PsA, worsens disease activity, pain and fatigue, impairs treatment response, and amplifies the risk of many cardiometabolic comorbidities already more prevalent in PsA. Despite the increasing evidence for the pathogenic role of obesity in PsA, current treatment focuses on immune mediated therapies, with limited attention to tackling excess adiposity. Residual pain and disease activity in PsA can in turn adversely impact physical activity, leading to a cycle of further weight gain and worse disease activity. Preliminary evidence from dietary interventions in patients with PsA and obesity suggests weight loss of≥5% body weight can improve disease activity, holding promise for potentially even better improvements with newer pharmacological anti-obesity therapies, such as incretin-based weight loss medicines, which result in average weight losses of 15-20%. In this narrative review, we provide an overview of the adverse impacts of obesity in PsA and discuss weight loss therapies now available to help address this. We highlight the urgent need for robust randomised controlled trials of weight loss therapies in patients with PsA and obesity to determine their clinical and cost effectiveness in PsA management and to inform where these are best implemented in the disease course and treatment pathway.

Health-related quality of life significantly improved in obese patients with psoriatic arthritis one year after a structured weight loss intervention

OBJECTIVE

In this interventional weight loss study, health-related quality of life (HRQoL), anxiety, depression and fatigue were compared at baseline (BL) and at 12 months (M12) in patients with psoriatic arthritis (PsA) and controls.

METHODS

PsA patients (n = 39) between 25 and 75 years of age, with body mass index (BMI) ≥ 33 kg/m2 were included in a weight loss intervention with very low energy diet (VLED) for 12 or 16 weeks depending on BL BMI < 40 or ≥ 40 kg/m2. The 36-item short-form health survey (SF-36) was used to assess HRQoL. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Assessments were done at BL, M3, M6 and M12. As controls (n = 39), obese individuals, already planned for VLED treatment were recruited and matched for sex, age and weight to the PsA patients.

RESULTS

In PsA patients, physical HRQoL, as demonstrated by the physical component summary (PCS) of SF-36, improved from median (IQR) 34 (25-45) at BL to 43 (34-50) at M12, p = 0.009. No significant effect on mental HRQoL, demonstrated by the mental component summary (MCS) score, was seen. Similarly in controls, PCS significantly improved (median IQR, 44 (36-50) at BL to 52 (44-55) at M12, p < 0.001), whereas no significant improvement was seen in MCS. Anxiety and depression decreased significantly in both PsA patients and controls.

CONCLUSIONS

The weight loss intervention was associated with significant improvements in physical HRQoL, as well as anxiety and depression, in PsA patients and controls.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016, retrospectively registered.

High-quality research on physical therapy in psoriatic arthritis is needed: a systematic review

Objectives

Although physical therapy is recommended as part of the non-pharmacological management of patients with psoriatic arthritis (PsA), the evidence is still unclear. Therefore, this study aimed to systematically review and appraise the quality of research on physical therapy in the management of patients with PsA.

Methods

In June 2024, a systematic literature search using four different databases (Medline, Embase, Web of Science and the Cochrane Library) was performed to include interventional and observational studies examining physical therapy in patients with PsA (PROSPERO ID 255501). A risk of bias assessment was conducted. Due to the wide variety of interventions and outcomes, a narrative synthesis was used.

Results

Of 9442 abstracts, 15 papers examining physical therapy uptake in clinical practice (N = 2) and different physical therapy interventions (N = 13) were included: cardiorespiratory exercises (N = 5), resistance exercises (N = 2), therapeutic modalities (N = 4) and mixed rehabilitation programs (N = 2). A low risk of bias was scored in only one RCT assessing cardiorespiratory exercises. The well-tolerated 11-week high-intensity interval training resulted in a long-term increase in peak oxygen uptake and a short-term decrease in truncal fat percentage in patients with low disease activity. Resistance training in patients with active disease did not increase muscle strength, but improved functional capacity, disease activity, pain and general health after the intervention. Evidence for other modalities was inconclusive.

Conclusion

High-quality evidence on physical therapy in PsA was scarce. Cardiorespiratory and resistance exercises demonstrated promising results to positively influence cardiometabolic risk as well as disease-related outcomes. Future research on physical therapy in PsA with adequate methodological quality is needed.

Difficult-to-Treat Psoriatic Arthritis: A Conceptual Approach

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Combined Effects of Diet and Physical Activity on Inflammatory Joint Disease: A Systematic Review and Meta-Analysis

Research evidence suggests that, individually, diet and physical activity are effective interventions for reducing levels of inflammation in inflammatory joint diseases (IJD), however little is known about their combined use. This systematic review and meta-analysis aimed to examine the effects and/or associations of combined diet and physical activity interventions in IJD, specifically rheumatoid arthritis (RA) and the spondyloarthropathies (SpA) (PROSPERO registration number: CRD42022370993). Ten out of 11 eligible studies examined RA patients. We found that a combination of diet/nutrition and physical activity/exercise improved Health Assessment Questionnaire score (standardized mean difference = -1.36, confidence interval (CI) = (-2.43)-(-0.30), I2 = 90%, Z = 2.5, p = 0.01), while surprisingly they increased erythrocyte sedimentation rate (mean difference = 0.20, CI = 0.09-0.31, I2 = 0%, Z = 3.45, p < 0.01). No effects were found on C-reactive protein or weight (p > 0.05) of RA patients. We did not find studies in other IJDs that provided sufficient data for a meta-analysis. The narrative data synthesis provided limited evidence to address our research question. No firm conclusions can be made as to whether the combination of diet/nutrition and physical activity/exercise affects inflammatory load in IJDs. The results of this study can only be used as a means of highlighting the low-quality evidence in this field of investigation and the need for further and better-quality research.