Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
Arthritis Res Ther. 2019 Jan 11;21(1):17. doi: 10.1186/s13075-019-1810-5.
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/m).
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.
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.
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.
ClinicalTrials.gov identifier: NCT02917434 , registered on September 21, 2016-retrospectively registered.
肥胖症在患有银屑病关节炎（PsA）的患者中较为常见，且与更高的疾病活动度、治疗效果较差和心血管发病率增加有关。然而，需要研究减肥的效果。本研究旨在前瞻性研究极低能量饮食（VLED）减肥治疗对符合银屑病关节炎（CASPAR 标准）和肥胖症（BMI≥33kg/m2）患者疾病活动度的影响。
VLED（640kcal/天）治疗持续 12-16 周，具体时长取决于治疗前的 BMI。之后，逐渐重新引入能量限制饮食。体重减轻治疗是在一个有组织的框架内进行的，以提供支持和医疗随访。在基线前 3 个月至 6 个月内，持续使用常规合成和/或生物疾病修饰抗风湿药物治疗。在基线、3 个月和 6 个月时，患者通过 BMI、66/68 关节计数、利兹肌腱附着点指数、银屑病体表面积（BSA）、调查问卷和 CRP 进行评估。主要结局是达到最小疾病活动度（MDA）的患者比例，次要结局是达到银屑病关节炎反应标准（PsARC）和美国风湿病学会（ACR）反应标准的患者比例。
共有 41/46 例患者完成了研究，63%为女性，中位年龄为 54 岁（IQR 48-62）。基线时，较高的 BMI 与更高的疾病活动度和较差的功能相关。体重平均减轻 18.7kg（IQR 14.6-26.5）或基线体重的 18.6%（IQR 14.7-26.3）。大多数疾病活动参数在减肥后显著改善，包括 68/66 个压痛/肿胀关节计数、CRP、BSA、利兹肌腱附着点指数、HAQ 和患者对全球健康、疼痛和疲劳的总体健康的视觉模拟评分。体重减轻幅度越大，改善程度越大，呈剂量反应关系。达到 MDA 的患者比例从 29%增加到 54%（p=0.002）。达到 PsARC 的患者比例为 46.3%。ACR20、50 和 70 反应率分别为 51.2%、34.1%和 7.3%。
短期 VLED 减肥治疗与肥胖症和银屑病关节炎患者关节、肌腱附着点和皮肤疾病活动度的显著积极影响相关。该研究支持肥胖症是银屑病关节炎疾病活动的促进因素这一假说。
ClinicalTrials.gov 标识符：NCT02917434，于 2016 年 9 月 21 日注册-回顾性注册。
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