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Mediterranean diet and exercise are associated with better disease control in psoriatic arthritis

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Abstract

Psoriatic arthritis (PsA) is associated with obesity and other related comorbidities, which impose an additional burden on disease activity and response to treatment. We investigated the impact of Mediterranean diet, and exercise on the presentation and severity of PsA. Three hundred fifty-five patients with PsA (n = 279) and psoriasis (PsO) (n = 76) were included in a cross-sectional study. Demographic and clinical characteristics and dietary and exercise patterns were recorded. Patients were grouped into (i) high, moderate, and low Mediterranean diet adherence and (ii) high, medium, and low activity level. Levels of diet and exercise were correlated with disease activity indices. PsA patients had more comorbidities than their PsO counterparts (42.7% vs. 26.3%, p = .038). The majority showed a low exercise pattern (total = 71.3%, PsA = 72.4%, PsO = 67.1%). Approximately half (total = 44.2%, PsA = 43.4%, PsO = 47.4%) did not follow a Mediterranean diet. Disease Activity in Psoriatic Arthritis Score (DAPSA) (p = .004), tender (p = .003) and swollen (p = .015) joint counts, erythrocyte sedimentation rate (ESR) (p = .001), and Psoriasis Area and Severity Index (PASI) (p = .015) had an inverse correlation with exercise. Higher Mediterranean diet adherence was associated with reduced ESR (p = .056), PASI (p = .011), and body surface area (BSA) (p = .009) indices. After adjusting for body mass index (BMI), exercise retained its positive correlation with PsA disease activity, but diet showed significant correlation only with enthesitis (p = 0.015). Uptake of a Mediterranean diet and exercise have positive effects on PsA activity, independently of BMI. These findings support lifestyle recommendations to supplement conventional treatment for improvement in disease outcomes.

Key points

• Diet and lifestyle are important influencers of health-related outcomes in PsA.

• In this cross-sectional study of 355 patients with psoriatic disease, we found that Med Diet and exercise improve outcomes in PsA independently of weight loss.

• Our results suggest that diet and lifestyle modifications should supplement conventional medical treatments.

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Data availability

Data may become available by the first author upon reasonable request.

References

  1. Veale DJ, Fearon U (2018) The pathogenesis of psoriatic arthritis. Lancet 391(10136):2273–2284. https://doi.org/10.1016/S0140-6736(18)30830-4

    Article  CAS  PubMed  Google Scholar 

  2. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P (2005) Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 64:ii14-7. https://doi.org/10.1136/ard.2004.032482

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ogdie A, Weiss P (2015) The epidemiology of psoriatic arthritis. Rheum Dis Clin North Am 41:545–568. https://doi.org/10.1016/j.rdc.2015.07.001

    Article  PubMed  PubMed Central  Google Scholar 

  4. Scotti L, Franchi M, Marchesoni A et al (2018) Prevalence and incidence of psoriatic arthritis: a systematic review and meta-analysis. Semin Arthritis Rheum 48:28–34. https://doi.org/10.1016/j.semarthrit.2018.01.003

    Article  PubMed  Google Scholar 

  5. FitzGerald O, Ogdie A, Chandran V, Coates LC, Kavanaugh A, Tillett W, Leung YY, deWit M, Scher JU, Mease PJ (2021) Psoriatic arthritis. Nat Rev Dis Primers 7(1):59. https://doi.org/10.1038/s41572-021-00293-y

    Article  PubMed  Google Scholar 

  6. Gupta S, Syrimi Z, Hughes DM et al (2021) Comorbidities in psoriatic arthritis: a systematic review and meta-analysis. Rheumatol Int 41:275–284. https://doi.org/10.1007/s00296-020-04775-2

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ogdie A, Schwartzman S, Husni ME (2015) Recognizing and managing comorbidities in psoriatic arthritis. Curr Opin Rheumatol 27:118–126. https://doi.org/10.1097/BOR.0000000000000152

    Article  PubMed  Google Scholar 

  8. Haraoui B, Liu PP, Papp KA (2012) Managing cardiovascular risk in patients with chronic inflammatory diseases. Clin Rheumatol 31:585–594. https://doi.org/10.1007/s10067-011-1921-0

    Article  PubMed  Google Scholar 

  9. Gulliver W (2008) Long-term prognosis in patients with psoriasis. Br J Dermatol 159(Suppl 2):2–9. https://doi.org/10.1111/j.1365-2133.2008.08779.x

    Article  CAS  PubMed  Google Scholar 

  10. Kimball AB, Guérin A, Tsaneva M, Yu AP, Wu EQ et al (2011) Economic burden of comorbidities in patients with psoriasis is substantial. J Eur Acad Dermatol Venereol 25:157–163. https://doi.org/10.1111/j.1468-3083.2010.03730.x

    Article  CAS  PubMed  Google Scholar 

  11. Coates LC, Soriano ER, Corp N, Bertheussen H, Callis Duffin K, Campanholo CB, Chau J, Eder L, Fernández-Ávila DG, FitzGerald O, Garg A, Gladman DD, Goel N, Helliwell PS, Husni ME, Jadon DR, Katz A, Laheru D, Latella J, Leung YY, Lindsay C, Lubrano E, Mazzuoccolo LD, Mease PJ, O’Sullivan D, Ogdie A, Olsder W, Palominos PE, Schick L, Steinkoenig I, de Wit M, van der Windt DA, Kavanaugh A (2022) GRAPPA Treatment Recommendations domain subcommittees. Author Correction: Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nat Rev Rheumatol 18(12):734. https://doi.org/10.1038/s41584-022-00861-w

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gwinnutt JM, Wieczorek M, Balanescu A et al (2023) 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. Ann Rheum Dis 82:48–56. https://doi.org/10.1136/annrheumdis-2021-222020

    Article  PubMed  Google Scholar 

  13. World Health Organization (2010) Global recommendations on physical activity for health. World Health Organization, Geneva 

  14. Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases (2002) Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation, Geneva, 28 January - 1 February 2002. https://apps.who.int/iris/handle/10665/42665. Accessed 10 Dec 2023

  15. Mart ́ınez-Gonza ́lez MA, Garc ́ıa-Arellano A, Toledo E, Salas-Salvado ́ J, Buil-Cosiales P et al (2012) A 14-Item Mediterranean Diet Assessment Tool and Obesity indexes among high-risk subjects: the PREDIMED trial. PLoS ONE 7(8):e43134. https://doi.org/10.1371/journal.pone.0043134

    Article  CAS  Google Scholar 

  16. Craig CL, Marshall AL, Sjostrom M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FB

    Article  PubMed  Google Scholar 

  17. Ritchlin CT, Colbert RA, Gladman DD (2017) Psoriatic arthritis. N Engl J Med. 376(10):957–970. https://doi.org/10.1056/NEJMra1505557

    Article  PubMed  Google Scholar 

  18. López-Medina C, Molto A, Sieper J et al (2021) Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study. RMD Open 7:e001450. https://doi.org/10.1136/rmdopen-2020-001450

    Article  PubMed  PubMed Central  Google Scholar 

  19. Eder L, Thavaneswaran A, Chandran V et al (2013) Gender difference in disease expression, radiographic damage and disability among patients with psoriatic arthritis. Ann Rheum Dis 72:578–582. https://doi.org/10.1136/annrheumdis-2012-201357

    Article  PubMed  Google Scholar 

  20. Shah K, Paris M, Mellars L, Changolkar A, Mease PJ (2017) Real-world burden of comorbidities in US patients with psoriatic arthritis. RMD Open 3(2):e000588. https://doi.org/10.1136/rmdopen-2017-000588

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ciaffi J, Mitselman D, Mancarella L, Brusi V, Lisi L, Ruscitti P, Cipriani P, Meliconi R, Giacomelli R, Borghi C, Ursini F (2021) The effect of ketogenic diet on inflammatory arthritis and cardiovascular health in rheumatic conditions: a mini review. Front Med 8:792846. https://doi.org/10.3389/fmed.2021.792846

    Article  Google Scholar 

  22. Hotamisligil GS (2017) Inflammation, metaflammation and immunometabolic disorders. Nature 542(7640):177–185. https://doi.org/10.1038/nature21363

    Article  CAS  PubMed  Google Scholar 

  23. Russolillo A, Iervolino S, Peluso R, Lupoli R, Di Minno A, Pappone N, Di Minno MN (2013) Obesity and psoriatic arthritis: from pathogenesis to clinical outcome and management. Rheumatology (Oxford) 52(1):62–67. https://doi.org/10.1093/rheumatology/kes242

    Article  CAS  PubMed  Google Scholar 

  24. Miele L, Vallone S, Cefalo C, La Torre G, Di Stasi C, Vecchio FM, D’Agostino M, Gabrieli ML, Vero V, Biolato M, Pompili M, Gasbarrini G, Rapaccini G, Amerio P, De Simone C, Grieco A (2009) Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. J Hepatol 51(4):778–786. https://doi.org/10.1016/j.jhep.2009.06.008

    Article  CAS  PubMed  Google Scholar 

  25. Husted JA, Thavaneswaran A, Chandran V, Eder L, Rosen CF, Cook RJ, Gladman DD (2011) Cardiovascular and other comorbidities in patients with psoriatic arthritis: a comparison with patients with psoriasis. Arthritis Care Res (Hoboken) 63(12):1729–1735. https://doi.org/10.1002/acr.20627.

    Article  PubMed  Google Scholar 

  26. Papadavid E, Katsimbri P, Kapniari I, Koumaki D, Karamparpa A, Dalamaga M, Tzannis K, Βoumpas D, Rigopoulos D (2016) Prevalence of psoriatic arthritis and its correlates among patients with psoriasis in Greece: results from a large retrospective study. J Eur Acad Dermatol Venereol 30(10):1749–1752. https://doi.org/10.1111/jdv.13700

    Article  CAS  PubMed  Google Scholar 

  27. Vallejo-Yagüe E, Burkard T, Micheroli R et al (2022) Minimal disease activity and remission in patients with psoriatic arthritis with elevated body mass index: an observational cohort study in the Swiss Clinical Quality Management cohort. BMJ Open 12:e061474. https://doi.org/10.1136/bmjopen-2022-061474

    Article  PubMed  PubMed Central  Google Scholar 

  28. Eder L, Abji F, Rosen CF, Chandran V, Gladman DD (2017) The association between obesity and clinical features of psoriatic arthritis: a case-control study. J Rheumatol 44(4):437–443. https://doi.org/10.3899/jrheum.160532

    Article  PubMed  Google Scholar 

  29. di Minno MN, Peluso R, Iervolino S, Lupoli R, Russolillo A, Scarpa R, di Minno G (2013) Obesity and the prediction of minimal disease activity: a prospective study in psoriatic arthritis. Arthritis Care Res (Hoboken) 65(1):141–147. https://doi.org/10.1002/acr.21711

    Article  PubMed  Google Scholar 

  30. Takeshita J, Grewal S, Langan SM, Mehta NN, Ogdie A, Van Voorhees AS, Gelfand JM (2017) Psoriasis and comorbid diseases: epidemiology. J Am Acad Dermatol 76(3):377–390. https://doi.org/10.1016/j.jaad.2016.07.064

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lupoli R, Pizzicato P, Scalera A et al (2016) Impact of body weight on the achievement of minimal disease activity in patients with rheumatic diseases: a systematic review and meta-analysis. Arthritis Res Ther 18:297. https://doi.org/10.1186/s13075-016-1194-8

    Article  PubMed  PubMed Central  Google Scholar 

  32. Constantin C, Surcel M, Munteanu A, Neagu M (2023) insights into nutritional strategies in psoriasis. Nutrients. 15(16):3528. https://doi.org/10.3390/nu15163528

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Kumthekar A, Ogdie A (2020) Obesity and psoriatic arthritis: a narrative review. Rheumatol Ther 7(3):447–456. https://doi.org/10.1007/s40744-020-00215-6

    Article  PubMed  PubMed Central  Google Scholar 

  34. Genel F, Kale M, Pavlovic N, Flood VM, Naylor JM, Adie S (2020) Health effects of a low-inflammatory diet in adults with arthritis: a systematic review and meta-analysis. J Nutr Sci 27(9):e37. https://doi.org/10.1017/jns.2020.31

    Article  CAS  Google Scholar 

  35. Katsimbri P, Korakas E, Kountouri A, Ikonomidis I, Tsougos E, Vlachos D, Papadavid E, Raptis A, Lambadiari V (2021) The effect of antioxidant and anti- inflammatory capacity of diet on psoriasis and psoriatic arthritis phenotype: nutrition as therapeutic tool? Antioxidants 10:157. https://doi.org/10.3390/antiox10020157

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Gotsis E, Anagnostis P, Mariolis A, Vlachou A, Katsiki N, Karagiannis A (2015) (2015) Health benefits of the Mediterranean diet: an update of research over the last 5 years. Angiology 66(4):304–318. https://doi.org/10.1177/0003319714532169

    Article  PubMed  Google Scholar 

  37. Caso F, Navarini L, Carubbi F, Picchianti-Diamanti A, Chimenti MS, Tasso M, Currado D, Ruscitti P, Ciccozzi M, Annarumma A, Laganà B, Perricone R, Afeltra A, Giacomelli R, Scarpa R, Costa L (2020) Mediterranean diet and psoriatic arthritis activity: a multicenter cross-sectional study. Rheumatol Int 40(6):951–958. https://doi.org/10.1007/s00296-019-04458-7

    Article  PubMed  Google Scholar 

  38. Leite BF, Morimoto MA, Gomes CMF et al (2022) Dietetic intervention in psoriatic arthritis: the DIETA trial. Adv Rheumatol 62:12. https://doi.org/10.1186/s42358-022-00243-6

    Article  PubMed  Google Scholar 

  39. Lubrano E, Scriffignano S, de Vlam K et al (2023) Triple jump for the optimal management of psoriatic arthritis: diet, sleep and exercise – a review. RMD Open 9:e003339. https://doi.org/10.1136/rmdopen-2023-003339

    Article  PubMed  PubMed Central  Google Scholar 

  40. Ford AR, Siegel M, Bagel J et al (2018) Dietary recommendations for adults with psoriasis or psoriatic arthritis from the medical board of the national psoriasis foundation: a systematic review. JAMA Dermatol 154(8):934–950. https://doi.org/10.1001/jamadermatol.2018.1412

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Rheumatology and Clinical Immunology Unit, Attikon” University Hospital, Chaidari , 12461, Athens, Greece

    Pelagia Katsimbri, Alexandros Grivas, Sofia Flouda, Georgia-Savina Moysidou, Maria Kosmetatou, Antonis Fanouriakis & Dimitrios T. Boumpas

  2. Second Department of Dermatology and Venereology, Attikon” University Hospital, Athens, Greece

    Evangelia Papadavid & Irene Kapniari

  3. Second Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece

    Kimon Tzannis

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  1. Pelagia Katsimbri
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Correspondence to Pelagia Katsimbri.

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Katsimbri, P., Grivas, A., Papadavid, E. et al. Mediterranean diet and exercise are associated with better disease control in psoriatic arthritis. Clin Rheumatol 43, 2877–2887 (2024). https://doi.org/10.1007/s10067-024-07080-6

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