Background PsA patients exhibit an increased prevalence of obesity. By leading to an abnormal expression of “adipokines” (TNF-α, IL-6, leptin, adiponectin), obesity determines a pro-inflammatory status. Thus, an interaction between obesity-related and immunity-related inflammatory status may be postulated in obese PsA subjects. Intervention studies showed that caloric restriction can reduce circulating inflammatory markers.
Objectives In this prospective study we correlated changes in the body weight with the minimal disease activity (MDA) achievement in PsA patients starting a treatment with TNF-α blockers.
Methods Among the 138 obese PsA subjects starting a TNF-α blockers treatment, 69 received a hypocaloric diet (HD, intervention group) and 69 a self-managed diet (SD, control group).
Both at baseline and after 6 months of follow-up, all patients underwent a complete clinical rheumatologic and laboratory evaluation in order to evaluate changes in metabolic variables, and the MDA achievement.
Results only 126 of the 138 PsA subjects completed the follow-up (63 HD and 63 matched SD subjects). Clinical and demographic characteristics were similar between HD and SD subjects. During the 6-months treatment with TNF-α blockers, 49 PsA subjects achieved the MDA.
HD was associated with a significantly higher Δ%ESR and with a trend to increased Δ%CRP as compared with the SD. The prevalence of successful (≥10% of weight loss) dietary intervention (p=0.001) showed a higher prevalence in MDA as compared to n-MDA subjects. HD was a predictor of MDA achievement (HR:4.79, p=0.002) after 6 months of treatment with TNF-α blockers as compared with SD subjects. A Kaplan-Meyer model confirmed a significant difference as to the 6-month MDA achievement between those with dietary intervention success and those without (Log Rank 10.432, p=0.001).
Conclusions This prospective study shows that the adherence to a hypocaloric, fiber-enriched diet is associated with an increased achievement of MDA in PsA subjects starting a TNF-α blockers treatment.
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Iervolino S, Di Minno MN, Peluso R, Lofrano M, Russolillo A, Di Minno G, Scarpa R. Predictors of Early Minimal Disease Activity in Patients with Psoriatic Arthritis Treated with Tumor Necrosis Factor-α Blockers. J Rheumatol. 2012 Jan 15. [Epub ahead of print]
Di Minno MN, Iervolino S, Peluso R, Scarpa R, Di Minno G on behalf of the CaRRDs study group. Carotid intima-media thickness in psoriatic arthritis: differences between tumor necrosis factor-α blockers and traditional disease-modifying antirheumatic drugs. Artherioscler Thromb Vasc Biol. 2011;31:705-12.
Disclosure of Interest None Declared
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