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Gopalarathinam R, Sankar R, Zhao SS. Role of Anti-Inflammatory Diet and Fecal Microbiota Transplant in Psoriatic Arthritis. Clin Ther 2024:S0149-2918(24)00112-7. [PMID: 38862291 DOI: 10.1016/j.clinthera.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Psoriatic arthritis (PsA) is a chronic inflammatory condition with complex and heterogenous manifestations. Although a myriad of treatment options including biologic medications are available to alleviate symptoms and slow disease progression, there is currently no cure for this condition. There has been a recent emergence of understanding about the relationship between the gut microbiome and immune-mediated inflammatory diseases. This has generated interest in the potential role of dietary interventions, particularly anti-inflammatory diets, and fecal microbiota transplant (FMT) as novel therapeutic approaches. The purpose of this narrative review is to examine the role of an anti-inflammatory diet and FMT in turn and whether their combination may offer alternate approaches for the management of PsA. METHODS Our non-systematic narrative review was informed by a literature search using PubMed and Google Scholar using the terms anti-inflammatory diet, FMT, nutrition supplements, and PsA. Preclinical studies and non-English language articles were excluded when synthesizing the narrative review. FINDINGS Current randomized controlled trials (RCTs) and observational evidence suggest that a hypocaloric diet or Mediterranean diet can help achieve weight loss among PsA patients who are overweight or obese, which in turn reduces inflammation and improves disease activity. However, there is no strong data to support the beneficial effects of intermittent fasting, vitamin supplements, turmeric supplements, probiotics, or omega-3 fatty acid supplements in PsA. Current evidence on the use of FMT in PsA is limited as only one small RCT has been conducted which did not demonstrate efficacy for improving clinical symptoms. IMPLICATIONS Clinicians can consider recommending hypocaloric or Mediterranean diets as an adjunct to standard management of PsA, possibly under the guidance of a dietician. Further research is needed to explore the beneficial effects of the synergistic role of combining an anti-inflammatory diet with FMT in PsA.
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Affiliation(s)
- Rajesh Gopalarathinam
- Division of Rheumatology, Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK.
| | - Reethika Sankar
- Meenakshi Medical College and Research Institute, Meenakshi Nagar, Tamil Nadu, India
| | - Sizheng Steven Zhao
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Tournadre A, Beauger M. Weight loss affects disease activity and treatment response in inflammatory rheumatic diseases. Joint Bone Spine 2024; 91:105647. [PMID: 37783311 DOI: 10.1016/j.jbspin.2023.105647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 10/04/2023]
Abstract
The quantity and quality of the adipose tissue is altered in obesity: hypertrophy of adipocytes, decrease in expandability, fibrosis, production of pro-inflammatory cytokines and adipokines, inflammatory infiltration by pro-inflammatory M1 macrophages and T lymphocytes. Excess adipose tissue and obesity are associated with low-grade inflammation that can aggravate chronic inflammatory diseases, decrease treatment efficacy, contribute to the development of comorbidities, and of the disease in its preclinical phase. Obesity increases the incidence of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis with a weight-dose effect. It is also a predictor of worse response to treatment, in particular TNF inhibitors. Weight loss induced by bariatric surgery decreases the risk of psoriasis and psoriatic arthritis and improves disease activity and remission in RA. A 5% weight loss through a low-calorie diet improves the response to TNF inhibitors in psoriatic arthritis, losing even more weight improves the response even more. In RA, the beneficial effect of weight loss from a low-calorie diet on disease activity has been reported in a few observational studies but has not been demonstrated in a randomized controlled trial. Screening and management of obesity are part of the dietary recommendations of the French Society for Rheumatology in patients with chronic inflammatory rheumatic diseases. Of course, this should be combined with other lifestyle modifications such as smoking cessation, higher food quality, increased physical activity and reduced sedentary behavior.
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Affiliation(s)
- Anne Tournadre
- Service de rhumatologie, hôpital G-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Unité de nutrition humaine, UMR1019 INRA, université Clermont-Auvergne, 63000 Clermont-Ferrand, France.
| | - Marine Beauger
- Service de rhumatologie, hôpital G-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
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Fagni F, Motta F, Schett G, Selmi C. Difficult-to-Treat Psoriatic Arthritis: A Conceptual Approach. Arthritis Rheumatol 2024; 76:670-674. [PMID: 38108094 DOI: 10.1002/art.42780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/23/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Filippo Fagni
- Friedrich-Alexander University Erlangen-Nürnberg, and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Francesca Motta
- IRCCS Humanitas Research Hospital and Humanitas University, Milan, Italy
| | - Georg Schett
- Friedrich-Alexander University Erlangen-Nürnberg, and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Carlo Selmi
- IRCCS Humanitas Research Hospital and Humanitas University, Milan, Italy
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Maharaj AB, Eder L, Ogdie A. The impact of dietary interventions in psoriatic arthritis. Curr Opin Rheumatol 2023; 35:414-422. [PMID: 37339523 DOI: 10.1097/bor.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE OF REVIEW Psoriatic arthritis (PsA) is a common form of inflammatory arthritis that affects people with psoriasis. Both psoriasis and PsA are associated with metabolic diseases including obesity, hypertension, hyperlipidaemia, diabetes mellitus, fatty liver disease, and cardiovascular disease including myocardial infarction. Dietary interventions for psoriatic disease have been of great interest, particularly among patients with PsA. RECENT FINDINGS Herein, we review the evidence for dietary intervention in psoriatic arthritis. To date, weight loss among patients who are obese has the greatest evidence for benefit. We also examine the evidence for fasting, nutrient supplementation, and specific diets as adjunct therapeutic strategies. SUMMARY While the data do not clearly support a single dietary intervention across the disease, weight loss among those who are obese results in improved PsA disease activity and physical function. Additional studies are needed to better understand the impact of diet on psoriatic arthritis.
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Affiliation(s)
- Ajesh B Maharaj
- Life Westville Hospital, Life Healthcare, Westville, South Africa
| | - Lihi Eder
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Diaz AJ, Rosety MA, Armario JC, Bandez MJ, Garcia-Gomez N, Sanchez-Sanchez E, Diaz J, Castejon-Riber C, Bernardi M, Rosety-Rodriguez M M, Ordonez FJ, Rosety I. Regular Exercise Improved Fatigue and Musculoskeletal Pain in Young Adult Psoriatic Patients without Psoriatic Arthritis. Nutrients 2023; 15:4563. [PMID: 37960216 PMCID: PMC10648681 DOI: 10.3390/nu15214563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Fatigue and musculoskeletal pain are also frequent in patients with psoriasis (PsO) without arthritis (PsA). The current study aimed to assess the impact of an intervention program based on aerobic training to reduce fatigue and musculoskeletal pain in patients with PsO without PsA. A total of 118 male patients with PsO volunteered in the current interventional study and were randomly allocated to the experimental (n = 59) or control group (n = 59). The intervention consisted of a 16-week aerobic training program on a treadmill, three sessions per week, consisting of a warm-up, 35-50 min treadmill exercise (increasing 5 min/4 weeks) at a work intensity of 50-65% of peak heart-rate (increasing 5%/4 weeks), and cooling-down. The functional assessment of chronic illness therapy fatigue scale (FACIT-Fatigue), health assessment questionnaire disability index (HAQ-DI), and visual analog scale (VAS) were compared pre and post intervention. Nutritional intake, maximal aerobic power, lipid profile, serum markers of muscle damage, and body composition were also assessed. When compared to baseline, FACIT-Fatigue, HAQ-DI, and VAS scores were significantly improved without increasing markers of muscle damage. Fat mass percentage, lipid profile, and maximal oxygen consumption were also improved. In conclusion, a 16-week aerobic training program at moderate intensity was safe, well tolerated, and effective in psoriatic patients without PsA. Long-term follow-up studies are required to examine whether these promising results may improve clinical outcomes.
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Affiliation(s)
- Antonio J. Diaz
- School of Nursing and Physiotherapy, University of Cadiz, Ana Viya Avenue, 52, 11009 Cadiz, Spain;
| | - Miguel A. Rosety
- School of Sports Sciences, University of Cadiz, Rep. Saharahui Avenue, 12, 11519 Cadiz, Spain;
| | - Jose C. Armario
- Dermatology Unit, School of Medicine, University of Cadiz, Fragela Square s/n, 11003 Cadiz, Spain;
| | - Manuel J. Bandez
- Biomedicine Department, School of Medicine, University of Cadiz, Fragela Square s/n, 11003 Cadiz, Spain;
| | - Natalia Garcia-Gomez
- Histology and Pathology Department, School of Medicine, University of Cadiz, Fragela Square s/n, 11003 Cadiz, Spain;
| | | | - Jara Diaz
- School of Sports Sciences, University of Cadiz, Rep. Saharahui Avenue, 12, 11519 Cadiz, Spain;
| | - Cristina Castejon-Riber
- School of Education Sciences, University of Cordoba, C/San Alberto Magno s/n, 14071 Cordoba, Spain;
| | - Marco Bernardi
- School of Sports Medicine, University La Sapienza, Ple. Aldo Moro 5, 00185 Rome, Italy;
| | - Manuel Rosety-Rodriguez M
- School of Sports Medicine, University of Cadiz, Virgen del Carmen s/n, 11100 Cadiz, Spain; (M.R.-R.M.); (F.J.O.)
| | - Francisco J. Ordonez
- School of Sports Medicine, University of Cadiz, Virgen del Carmen s/n, 11100 Cadiz, Spain; (M.R.-R.M.); (F.J.O.)
| | - Ignacio Rosety
- Human Anatomy Department, School of Medicine, University of Cadiz, Fragela Square s/n, 11003 Cadiz, Spain;
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Gezer HH, Acer Kasman S, Duruöz MT. Autonomic dysfunction and cardiovascular risk in psoriatic arthritis. Clin Rheumatol 2023; 42:2635-2649. [PMID: 36542174 DOI: 10.1007/s10067-022-06484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
Psoriatic arthritis (PsA) is an inflammatory disease with a high prevalence of cardiovascular (CV) events due to traditional cardiovascular risk factors and increased systemic inflammation. In this review, our objectives were to (i) evaluate the cardiovascular events and risk factors and (ii) investigate the relationship between autonomic dysfunction and CV diseases in PsA. A systematic review of the literature was done on the Medline/PubMed, Scopus, and the Directory of Open Access Journals databases between January 2017 and July 2022. After screening and exclusions, 73 studies were included for the final review. Patients with PsA have a greater risk of CV diseases and increased traditional CV risk factors, including hypertension, diabetes mellitus, obesity, metabolic syndrome, and dyslipidemia. Although autonomic dysfunction is more common in PsA than in the general population, its relationship with increased CV diseases in these patients is still unclear. Limitations in explaining CV risk in these patient groups complicate patient assessment as cardiovascular risk factors are linked to the morbidity and mortality of PsA, and it is essential to improve an optimal screening and management strategy for CV disease. All CV risk scoring systems cannot fully assess the CV risk in these patients, so in addition to scoring systems, carotid ultrasound evaluation may be a part of the CV evaluation.
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Affiliation(s)
- Halise Hande Gezer
- Department of Rheumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey.
| | - Sevtap Acer Kasman
- Department of Rheumatology, Kartal Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Mehmet Tuncay Duruöz
- Rheumatology Division, PMR Department, Marmara University School of Medicine, Istanbul, Turkey
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Grygiel-Górniak B, Skoczek W. Molecular Background and Clinical Implications of Glucose Disorders in Patients with Psoriatic Arthritis. J Clin Med 2023; 12:5814. [PMID: 37762754 PMCID: PMC10532042 DOI: 10.3390/jcm12185814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/22/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease characterized by joint and entheses involvement. This condition is often associated with an increased prevalence of obesity, encompassing more than one-third of all patients. Given the presence of metabolic disorders, it becomes crucial to enhance clinical oversight of metabolic parameters. An early diagnosis of glucose irregularities in PsA allows for the assessment of an effective treatment strategy. The approach proves valuable in preventing the development of insulin resistance (IR) or diabetes mellitus type 2 (DMt2). Similar pathways characterize the pathomechanism of PsA and DMt2, offering an innovative perspective on treatment management. The cytokines and adipokines synthesized in the course of PsA significantly impact the development process of IR and DMt2 in different mechanisms of action. Conversely, glucose disorders influence the activity of PsA and therapy outcomes. Given the chronic inflammatory background shared by PsA, obesity, and DMt2, it is evident that inadequate management of any of the mentioned conditions can exacerbate the others. Thus, when PsA coincides with DMt2, a comprehensive multidimensional approach is necessary. This includes an effective immunosuppressive regimen complemented by appropriate anti-diabetic and insulin therapies. Moreover, often overlooked recommendations concerning overall well-being and lifestyle adjustments hold significance. This manuscript explores the connections and the relationship between the molecular background of PsA and glucose disorders. It provides a detailed exposition of specific therapeutic approaches for both conditions.
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Affiliation(s)
- Bogna Grygiel-Górniak
- Department of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland
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Hailey LH, Amarnani R, Bundy C, McGagh D, James L, Kirtley S, O'Sullivan D, Steinkoenig I, Suribhatla R, Vivekanantham A, Coates LC. Lifestyle Modifications and Nonpharmacologic Interventions to Improve Outcomes in Psoriatic Arthritis: A Systematic Review. Clin Ther 2023; 45:841-851. [PMID: 37541907 DOI: 10.1016/j.clinthera.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE Psoriatic arthritis (PsA) is a multisystem inflammatory disorder associated with significant mortality and morbidity, including functional impairment and psychological disability. Although evidence-based treatment recommendations are available for the use of drug treatments in PsA, there is little guidance for health professionals on nonpharmacologic and psychological interventions that may be useful in PsA. The objective of this systematic review (SR) was to identify how lifestyle modifications and the use of nonpharmacologic and psychological interventions may improve the outcomes of patients with PsA. METHODS Studies were included if they evaluated adults diagnosed with PsA and included exposure to nonpharmacologic interventions, psychological interventions, and lifestyle modifications. The outcomes used needed to have been validated in PsA. A systematic literature search was run on May 28, 2021, in the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), EMBASE, Global Health, MEDLINE, and PsycINFO databases to identify articles related to lifestyle modifications and nonpharmacologic or psychological interventions for adults with PsA published between 2010 and 2021. Two review authors independently screened and selected full-text studies for inclusion in the SR. Risk of bias was assessed with either the Risk of Bias 2 (ie, RoB 2) tool or Critical Appraisal Skills Program checklist depending on the study type. FINDINGS The search strategy identified 26,132 references. Eight studies examining lifestyle modifications and the effect on PsA were eligible to be included in the SR. Three of the 8 studies were randomized controlled trials, and 5 were nonrandomized studies. Three studies assessed physical activity, 3 assessed diet, 1 study assessed smoking, and another study assessed mud bath therapy. There was large heterogeneity between studies, and the measures of disease activity, and psychological and functional outcomes varied widely between studies. IMPLICATIONS Although this SR identified 8 relevant studies, these studies did not provide high-quality evidence to guide patients for non-drug treatments of PsA. The effectiveness of these interventions has therefore not been established. We found that physical activity seems to have a positive impact on disease activity and psychological well-being. Further well-designed research studies are needed to develop treatment recommendations. PROSPERO identifier: CRD42021257404.
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Affiliation(s)
- Louise H Hailey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Chris Bundy
- Behavioural Medicine/Health Psychology School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Dylan McGagh
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Lija James
- Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Rhea Suribhatla
- Oxford Medical School, University of Oxford, Oxford, United Kingdom
| | - Arani Vivekanantham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
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Rastogi S, Pandey P, Kumar S, Verma A, R C. 'Obesity and arthritis' as the morbid duo: Designing and experimenting a novel strategy for weight reduction at a secondary care ayurveda -arthritis center. J Ayurveda Integr Med 2023; 14:100722. [PMID: 37244779 PMCID: PMC10692377 DOI: 10.1016/j.jaim.2023.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/15/2023] [Accepted: 05/08/2023] [Indexed: 05/29/2023] Open
Abstract
Obesity has been a critical confounding factor in arthritis. Its impacts are seemingly more apparent in conditions like knee osteoarthritis but it affects the net outcome in almost every type of arthritis. Reduction of weight is the obvious first advice by a treating physician in such cases. In the absence of a clear roadmap however to reach the goal, It remains an unmet advise for most arthritis patients. Obesity combined with arthritis, becomes a morbid combination where addition of weight adds to intensity of arthritis and arthritis induced limitation of movements adds to the weight. Weight reduction is much tougher in arthritis due to the physical limitations. Noticing this gap of knowledge between desired and achieved, Ayurveda -arthritis treatment and advanced research center at Lucknow has designed a strategic plan as a real help to such people and executed it through the activities focusing upon educating the obese arthritis patients for causes and concerns of obesity in general and individualized management plan through an interactive workshop. A workshop of its own kind was conducted on 24 April 2022. 28 obese arthritics as participants had offered to understand the real need and feasibility of doing these strategically focused activities aiming at weight reduction. This has come up as a new opportunity of help to the obese arthritis patients by empowering them with practical knowledge and tools to reduce weight suiting to their individual capacities and needs. The feedback of the participants provided at the end of the workshop was highly encouraging and has shown that strategically focused activities to bridge the gaps in clinical practice are highly desired and useful.
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Affiliation(s)
- Sanjeev Rastogi
- Ayurveda - Arthritis Treatment and Advanced Research Center (A-ATARC), State Ayurvedic College and Hospital, Tulsi Das Marg, Lucknow, 226003, India.
| | - Preeti Pandey
- Ayurveda - Arthritis Treatment and Advanced Research Center (A-ATARC), State Ayurvedic College and Hospital, Tulsi Das Marg, Lucknow, 226003, India
| | - Sumit Kumar
- Ayurveda - Arthritis Treatment and Advanced Research Center (A-ATARC), State Ayurvedic College and Hospital, Tulsi Das Marg, Lucknow, 226003, India
| | - Ankita Verma
- Ayurveda - Arthritis Treatment and Advanced Research Center (A-ATARC), State Ayurvedic College and Hospital, Tulsi Das Marg, Lucknow, 226003, India
| | - Chinmayi R
- Ayurveda - Arthritis Treatment and Advanced Research Center (A-ATARC), State Ayurvedic College and Hospital, Tulsi Das Marg, Lucknow, 226003, India
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Lubrano E, Scriffignano S, de Vlam K, Ronga M, Perrotta FM, Lories R. Triple jump for the optimal management of psoriatic arthritis: diet, sleep and exercise - a review. RMD Open 2023; 9:e003339. [PMID: 37648398 PMCID: PMC10471880 DOI: 10.1136/rmdopen-2023-003339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
Psoriatic arthritis (PsA) is a complex, multiform and chronic inflammatory disease characterised by the association of arthritis and psoriasis combined with other related conditions and comorbidities. Treatment of PsA has rapidly evolved by the introduction of new biological drugs and small molecules which allow to achieve disease remission or low disease activity in most of the patients. However, unmet treatment needs still persist for those patients with persistent disease activity or symptoms, impaired function, reduced quality of life or comorbidities. In this context, non-pharmacological approaches, including diet modifications, an adequate sleep quality and physical activity could provide additional benefits. In recent years, diet modifications, improvement of sleep quality and physical activity became an area of interest for researchers and some studies showed how a holistic non-pharmacological approach may ameliorate the quality of life of patients with PsA.The aim of this manuscript was to review the current evidence on the intriguing link and potential effects of diet, sleep and exercise in PsA patients. In particular, we reviewed the literature focusing on the possible benefits of a holistic approach to PsA patients considering lifestyle modifications.
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Affiliation(s)
- Ennio Lubrano
- Dipartimento di Medicina, Università degli Studi del Molise, Campobasso, Italy
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Cente, KU Leuven, Leuven, Belgium
| | - Silvia Scriffignano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Universita degli Studi del Molise, Campobasso, Italy
| | - Kurt de Vlam
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Mario Ronga
- Department of Health Sciences, Università degli Studi del Piemonte Orientale Amedeo Avogadro Facoltà di Medicina e Chirurgia, Novara, Italy
| | - Fabio Massimo Perrotta
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Universita degli Studi del Molise, Campobasso, Italy
| | - Rik Lories
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Cente, KU Leuven, Leuven, Belgium
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Landgren AJ, Jonsson CA, Bilberg A, Eliasson B, Torres L, Dehlin M, Jacobsson LTH, Gjertsson I, Larsson I, Klingberg E. Serum IL-23 significantly decreased in obese patients with psoriatic arthritis six months after a structured weight loss intervention. Arthritis Res Ther 2023; 25:131. [PMID: 37501212 PMCID: PMC10373368 DOI: 10.1186/s13075-023-03105-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Patients with psoriatic arthritis (PsA) are frequently obese. We have previously shown decreased disease activity in patients with PsA with a body mass index (BMI) ≥ 33 kg/m2 following weight loss treatment with Very Low Energy Diet (VLED), resulting in a median weight loss of 18.6% at six months (M6) after baseline (BL). In this study we assessed the effects of VLED on cytokines and adipokines at M6 in the same patients with PsA and controls (matched on sex, age and weight). METHODS VLED (640 kcal/day) during 12 or 16 weeks, depending on BL BMI < 40 or ≥ 40 kg/m2, was taken and followed by an energy-restricted diet. Cytokines and adipokines were measured with Magnetic Luminex Assays at BL and M6. RESULTS Serum interleukin (IL)-23, (median (interquartile range) 0.40 (0.17-0.54) ng/mL vs. 0.18 (0.10-0.30) ng/mL, p < 0.001) and leptin (26.28 (14.35-48.73) ng/mL vs. 9.25 (4.40-16.24) ng/mL, p < 0.001) was significantly decreased in patients with PsA. Serum total (tot)-adiponectin and high molecular weight (HMW) adiponectin increased significantly. Similar findings were found in controls. Also, in patients with PsA, ∆BMI was positively correlated with ∆IL-23 (rS = 0.671, p < 0.001). In addition, significant positive correlations were found between ΔBMI and ΔDisease Activity Score (DAS28CRP), ΔCRP, Δtumor necrosis factor (TNF)-α, ΔIL-13, ∆IL-17 and Δleptin, and negative correlations between ΔBMI and Δtot-adiponectin. CONCLUSIONS Weight loss was associated with decreased levels of leptin and cytokines, in particular IL-23. These findings may partly explain the anti-inflammatory effect of weight reduction in PsA. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016, retrospectively registered.
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Affiliation(s)
- A J Landgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Södra Bohuslän, Sweden.
| | - C A Jonsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - B Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Torres
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I Gjertsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Larsson
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Queiro R, Aurrecoechea E, Alonso Castro S, Villa Blanco I, Brandy-Garcia A, Linge R. Interleukin-17-targeted treatment in patients with spondyloarthritis and associated cardiometabolic risk profile. Front Immunol 2023; 14:1203372. [PMID: 37533855 PMCID: PMC10391638 DOI: 10.3389/fimmu.2023.1203372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Spondyloarthritis is a group of immune-mediated rheumatic disorders that significantly impact patients' physical function and quality of life. Patients with spondyloarthritis experience a greater prevalence of cardiometabolic disorders, such as obesity, hypertension, dyslipidemia and diabetes mellitus, and these comorbidities are associated with increased spondyloarthritis disease activity and risk of cardiovascular events. This narrative review summarizes the evidence for a physiological link between inflammatory status and cardiometabolic comorbidities in spondyloarthritis, as well as the impact of interleukin (IL)-17 blockade versus other molecular mechanisms in patients with cardiometabolic conditions. The IL-23/IL-17 axis plays a pivotal role in the pathophysiology of spondyloarthritis by promoting inflammation and tissue remodeling at the affected joints and entheses. The importance of the IL-23/IL-17 signaling cascade in underlying sub-clinical inflammation in common cardiometabolic disorders suggests the existence of shared pathways between these processes and spondyloarthritis pathophysiology. Thus, a bidirectional relationship exists between the effects of biologic drugs and patients' cardiometabolic profile, which must be considered during treatment decision making. Biologic therapy may induce changes in patients' cardiometabolic status and cardiometabolic conditions may conversely impact the clinical response to biologic therapy. Available evidence regarding the impact of IL-17 blockade with secukinumab on cardiometabolic parameters suggests this drug does not interfere with traditional cardiovascular risk markers and could be associated with a decreased risk of cardiovascular events. Additionally, the efficacy and retention rates of secukinumab do not appear to be negatively affected by obesity, with some studies reporting a positive impact on clinical outcomes, contrary to that described with other approaches, such as tumor necrosis factor blockade. In this article, we also review evidence for this bidirectional association with other treatments for spondyloarthritis. Current evidence suggests that IL-17-targeted therapy with secukinumab is highly effective in spondyloarthritis patients with cardiometabolic comorbidities and may provide additional cardiometabolic benefits.
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Affiliation(s)
- Rubén Queiro
- Rheumatology and Health Research Institute of the Principality of Asturias (ISPA) Translational Immunology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
- Oviedo University School of Medicine, Oviedo, Spain
| | - Elena Aurrecoechea
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Sara Alonso Castro
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ignacio Villa Blanco
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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Queiro R, Loredo M, Braña I, Pardo E, Alonso S, Alperi M. Managing psoriatic arthritis in different clinical scenarios. Expert Rev Clin Immunol 2023; 19:1469-1484. [PMID: 37589128 DOI: 10.1080/1744666x.2023.2249235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic, immune-mediated disease characterized by synovio-entheseal inflammation. It is estimated to affect around 30% of patients with psoriasis and significantly reduces patients' physical function and quality of life. There is a growing number of treatment options for PsA, but due to the heterogeneous clinical features of the disease and prevalence of comorbidities, managing PsA can be challenging. AREAS COVERED In this article, we review current understanding of the disease and available pharmacological options. Based on published treatment guidelines, emerging evidence and clinical experience, we provide our expert opinion on treatment strategies, taking into consideration the predominant disease domain and the presence of comorbidities, which can impact treatment decisions and clinical outcomes. EXPERT OPINION Biological and targeted synthetic disease-modifying agents are dramatically improving the lives of patients with PsA. Biosimilar TNF inhibitors offer a particularly versatile and cost-effective option, whilst newer biologics and targeted synthetic molecules that can be used to treat most domains of psoriatic disease are an attractive alternative to TNF inhibitors. Despite a lack of consensus on treatment sequencing and tapering, it is important that PsA patients, especially those with comorbidities, are looked after by a multidisciplinary team to optimize their care.
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Affiliation(s)
- Rubén Queiro
- Rheumatology & ISPA Translational Immunology Division, Central University Hospital of Asturias, Oviedo, Spain
- Department of Medicine, Oviedo University School of Medicine, Oviedo, Spain
| | - Marta Loredo
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Ignacio Braña
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Estefanía Pardo
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Sara Alonso
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Mercedes Alperi
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
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Ortolan A, Felicetti M, Lorenzin M, Cozzi G, Ometto F, Striani G, Favero M, Doria A, Ramonda R. The impact of diet on disease activity in spondyloarthritis: A systematic literature review. Joint Bone Spine 2023; 90:105476. [PMID: 36404571 DOI: 10.1016/j.jbspin.2022.105476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Our study aimed to systematically review the evidence about the effect of diet or dietary supplements on spondyloarthritis (SpA) disease activity. METHODS a systematic literature review (SLR) was conducted in MEDLINE, EMBASE, Cochrane and SCOPUS according to the "PEO" format (Population, Exposure, Outcome). The population was SpA (axial or peripheral, axSpA/pSpA, including Psoriatic Arthritis-PsA); the intervention any kind of diet/dietary supplement; the outcome disease activity. Inclusion criteria were: adult patients, Randomized Controlled Trials (RCTs) and longitudinal studies (so that a pre-and post-intervention assessment were available), papers in English. Risk of bias (RoB) was conducted with different tools according to the design of the study. RESULTS Literature search yielded 1390 publications, of which 15 were finally inlcuded: 12 interventional and 3 observational studies. Among those with the lower RoB: a) 2 RCTs, one at unclear and one at low RoB, failed to show benefit of probiotics in SpA b) Two RCTs at unclear RoB provided evidence that weight loss, but not hypocaloric diet, was associated to MDA achievement in PsA. The remaining interventional studies were at high RoB. Among the observational studies, one study on Mediterranean diet demonstrated an association between diet adherence and a ≥ 20% decrease of ASDAS in axSpA. The other two observational studies were judged of poor quality. CONCLUSIONS weight loss seem to be able to impact disease activity in PsA, while probiotics do not seem useful in SpA; evidence for dietary behaviors is scarce and heterogeneous.
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Affiliation(s)
- Augusta Ortolan
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Giacomo Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Francesca Ometto
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy; ULSS 6 Euganea Company, Padova, Italy
| | - Giovanni Striani
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Marta Favero
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy; Internal Medicine Unit I, Ca' Foncello Hospital, Treviso, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy.
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Daugaard C, Iversen L, Hjuler KF. Comorbidity in Adult Psoriasis: Considerations for the Clinician. PSORIASIS (AUCKLAND, N.Z.) 2022; 12:139-150. [PMID: 35712227 PMCID: PMC9196664 DOI: 10.2147/ptt.s328572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/24/2022] [Indexed: 01/19/2023]
Abstract
Psoriasis is associated with several comorbidities ranging from cardiovascular comorbidity and mental disorders to other immune mediated inflammatory diseases. However, most of these co-morbidities are often overlooked or diagnosed late. Furthermore, evidence suggests that comorbidities are undertreated. Here, we provide an overview of comorbidities in psoriasis and present a simple rundown of considerations of relevance to the clinician. We hope that this review may raise clinicians' awareness of comorbidities in psoriasis and provide simple guidance regarding screening tools and treatment decisions in psoriasis with comorbidities.
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Affiliation(s)
- Christine Daugaard
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Iversen
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
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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. Clin Rheumatol 2022; 41:2745-2754. [PMID: 35648298 PMCID: PMC9474576 DOI: 10.1007/s10067-022-06164-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/21/2022]
Abstract
Objectives To evaluate the effects of weight loss treatment on physical fitness in patients with psoriatic arthritis (PsA) and obesity compared to matched controls. Methods In total, 46 patients with PsA (CASPAR) and BMI ≥ 33 kg/m2 and 52 obese persons were included in this 12-month prospective open intervention study with a very low energy diet (640 kcal/day), followed by structured reintroduction of an energy-restricted diet and brief support for physical activity. The primary outcome was muscle strength assessed with hand-grip strength (Grippit) and leg muscle strength (timed stand test). Secondary outcomes were cardiorespiratory fitness, body composition, and physical functioning (SF-36PCS). Outcomes were assessed at baseline, 6 (M6), and 12 months (M12). Nonparametric statistics were used. Results Median weight reduction at M6 was 18.9 kg in patients and 23.0 kg in controls, (p = 0.546). At M12, patients’ median weight loss from baseline was 16.1 kg, corresponding with significant loss of total fat mass (− 30.1%), and lean mass (total − 7.0%, arm − 13.7%, and leg − 6.0%). Leg muscle strength improved in patients and controls at M6 (p < 0.001) and remained improved at M12 (p < 0.01), while hand-grip strength was unchanged in both groups. Cardiorespiratory fitness increased in controls at M6 (p = 0.018) and M12 (p = 0.028) but not in patients. Physical functioning improved in both groups at M6 (p < 0.001) and remained improved at M12 (p = 0.008) and (p < 0.01), respectively. Conclusion The intervention resulted in positive effects on body weight and total body fat. Despite reduced lean body mass, the muscle strength did not deteriorate in patients with PsA and controls. Trial registration ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016-retrospectively registered.
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Darlenski R, Mihaylova V, Handjieva-Darlenska T. The Link Between Obesity and the Skin. Front Nutr 2022; 9:855573. [PMID: 35369048 PMCID: PMC8965625 DOI: 10.3389/fnut.2022.855573] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Obesity as a multi-organ disease that affects the entire human organism. Notably, the skin is no exclusion from this postulate. Skin changes in obese patients have been widely studied with regards to mechanical friction, skin infections, and skin hypertrophic conditions, such as acanthosis nigricans and, most commonly, fibromas (skin tags). Almost 60–70% of obese patients present with a variety of skin changes. Herein, we discuss our own experience and review the complex skin changes in obesity. The role of metabolic syndrome and obesity are responsible for the epidemiological prevalence and are involved in the pathogenesis of chronic inflammatory skin diseases, such as psoriasis, atopic dermatitis, and skin malignancies. Here, we comment on the role of nutritional interventions in these patients as it has been proven that low-calorie diet and weight loss is related to improvement of inflammatory skin diseases. The readership of this paper will receive up-to-date overview on the connection between obesity and the skin that is of a practical importance to any clinician working in the field.
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Affiliation(s)
- Razvigor Darlenski
- Department of Dermatology and Venereology, Acibadem Cityclinic Tokuda Hospital, Sofia, Bulgaria
- Department of Dermatology and Venereology, Trakia University, Stara Zagora, Bulgaria
- *Correspondence: Razvigor Darlenski,
| | - Vesselina Mihaylova
- Department of Pharmacology and Toxicology, Medical Faculty, Medical University, Sofia, Bulgaria
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Ramírez J, Azuaga-Piñango AB, Celis R, Cañete JD. Update on Cardiovascular Risk and Obesity in Psoriatic Arthritis. Front Med (Lausanne) 2021; 8:742713. [PMID: 34692732 PMCID: PMC8531250 DOI: 10.3389/fmed.2021.742713] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/13/2021] [Indexed: 12/23/2022] Open
Abstract
PsA is characterized by a high prevalence of cardiovascular (CV) comorbidities. Recognizing these comorbidities is critical due to their influence on the quality of life and the choice of therapy. Imaging techniques also play an important role in the evaluation of the CV risk in psoriatic disease, improving the prediction of CV events when combined with clinical scores as a predictive tool. Meta-analyses point to a significant reduction in the incidence of CV events associated with the suppression of inflammatory activity when using systemic therapies. Consequently, the mortality rate in PsA patients has fallen in the last 40 years and is now similar to that of the general population, including cardiovascular causes. Obesity is an especially relevant CV comorbidity in patients with psoriatic disease, most of whom are overweight/obese. Body mass index (BMI) is a risk factor for PsA and a causal relationship with psoriasis has been demonstrated by Mendelian randomized studies. The study of fat distribution shows that patients with psoriasis are characterized by visceral fat accumulation, which correlates with CV risk measurements. These findings suggest that approaches to the prevention and treatment of psoriatic disease might come from targeting adiposity levels, in addition to the immune pathways. Weight loss treatment with low energy diets in patients with PsA has been associated with significant improvements in disease activity. Novel strategies using a multimorbidity approach, focused more on patients outcomes, are necessary to better address comorbidities, improve clinical outcomes and the quality of life of patients with psoriatic disease.
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Affiliation(s)
- Julio Ramírez
- Arthritis Unit, Department of Rheumatology, Hospital Clínic, Barcelona, Spain
| | | | - Raquel Celis
- Arthritis Unit, Department of Rheumatology, Hospital Clínic, Barcelona, Spain
| | - Juan D Cañete
- Arthritis Unit, Department of Rheumatology, Hospital Clínic, Barcelona, Spain
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Mulder MLM, Wenink MH, Vriezekolk JE. Being overweight is associated with not reaching low disease activity in women but not men with Psoriatic Arthritis. Rheumatology (Oxford) 2021; 61:770-774. [PMID: 33831180 DOI: 10.1093/rheumatology/keab338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/02/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To assess sex differences in disease activity parameters and health-related quality of life in Psoriatic arthritis (PsA), and to assess whether determinants associated with not reaching treatment target differed between men and women. METHODS Routine practice data of 855 PsA patients, who were all tightly monitored and treated, was used. Sex differences including, but not limited to, Psoriatic Arthritis Disease Activity Score (PASDAS), skin/nail disease, SF12-PCS/MCS, and inflammatory back pain (IBP) were assessed. Multivariate analyses were used to examine determinants associated with not reaching treatment target (PASDAS≤3.2) in men and women. RESULTS Women had worse scores for - among others- swollen and tender joints, CRP, enthesitis, and function (all P < 0.001). Higher PASDAS scores were found for women (3.5±1.5) than men (2.7±1.5, p < 0.001). Likewise, women were more often not at PASDAS treatment target (OR = 2.03, P < 0.001). No difference in current medication use was found. Nail disease, IBP, number of DMARDs used (past and current), and Body Mass Index (BMI) were associated with not reaching treatment target in the overall sample. For women, but not men, BMI was associated with not reaching PASDAS low disease activity (LDA) (OR between 2.41-3.43, P < 0.001). CONCLUSIONS Women with PsA in a tightly monitored and treated setting have more severe disease than men. This is demonstrated by worse scores for women in both subjective and objective disease activity measures, in addition to women less often reaching the treatment target. Notably, being overweight is associated with higher disease activity in women, but not men.
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Affiliation(s)
- Michelle L M Mulder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark H Wenink
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Johanna E Vriezekolk
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, The Netherlands
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Navigating the diverse immune landscapes of psoriatic arthritis. Semin Immunopathol 2021; 43:279-290. [PMID: 33721040 DOI: 10.1007/s00281-021-00848-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
The goal of remission in psoriatic arthritis (PsA) has remained elusive despite the influx of a range of new therapies over the last 20 years. In contrast, therapeutic responses to agents that inhibit IL-23 or IL-17 have demonstrated impressive efficacy in psoriasis. In part, the divergent responses in these two disorders are likely related to the heterogeneity of tissue involvement in PsA and the interplay of multiple different cell populations and molecular pathways. In this narrative review, we will examine the plasticity of the immune response in PsA from the perspective of the Th17 cell and monocyte and discuss recent findings regarding the importance of CD8+ T resident cells in disease pathogenesis. We will then examine the effects of cytokines on epithelial cell and stromal populations and finally discuss new data regarding immune cell and tissue resident cell cross-talk in entheses and bone. Lastly, the potential therapeutic targets that have emerged from these investigations will be discussed.
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Perrotta FM, Scriffignano S, Benfaremo D, Ronga M, Luchetti MM, Lubrano E. New Insights in Physical Therapy and Rehabilitation in Psoriatic Arthritis: A Review. Rheumatol Ther 2021; 8:639-649. [PMID: 33710586 PMCID: PMC8217348 DOI: 10.1007/s40744-021-00298-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/03/2021] [Indexed: 01/18/2023] Open
Abstract
Psoriatic arthritis (PsA) is a complex, multiform and chronic inflammatory disease characterized by the association of psoriasis and arthritis with other musculoskeletal and extra-articular manifestations. The treatment of PsA is rapidly evolving due to the introduction of new biologic and small-molecule drugs, and the aim of treatment is to induce a condition of remission or low disease activity in all disease domains. However, unmet treatment needs still persist for those patients with impaired function, reduced quality of life or comorbidities. In this context, physical therapy and rehabilitation could provide additional benefits by reducing disease activity and improving function. Although a large number of studies have assessed the role of physical therapy and exercise in other forms of chronic inflammatory arthritis, such as axial spondyloarthritis and rheumatoid arthritis, evidence on their effect on persons with PsA is still lacking. However, some studies have reported the potential positive role of physical therapy on the different disease domains of PsA, in helping to improve disease activity, prevent or improve articular impairment, improve pain management and improve quality of life. Here, we review current evidence on physical therapy, exercise and rehabilitation in patients with PsA. In particular, we review the literature focusing on each domain, to provide evidence of efficacy and effectiveness of exercise and rehabilitation on skin, peripheral arthritis, axial involvement, dactylitis, enthesitis and comorbidities.
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Affiliation(s)
- Fabio Massimo Perrotta
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Silvia Scriffignano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Devis Benfaremo
- Clinica Medica, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Mario Ronga
- Orthopedics and Trauma Operative Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University Hospital G. Martino, University of Messina, Messina, Italy
| | - Michele Maria Luchetti
- Clinica Medica, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy.
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