June 25, 2018
3 min read
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Dietary modification reduces disease severity in patients with PsA, psoriasis

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The National Psoriasis Foundation’s medical board strongly recommends dietary weight loss with a hypocaloric diet for overweight and obese patients with psoriasis, and weakly suggests that overweight or obese patients with psoriatic arthritis both supplement their diet with vitamin D and lose weight.

Perspective from Carrie Beach, BSN, RN

The recommendations are the result of a systematic literature review published in JAMA Dermatology.

“Regardless of patients’ perspectives on established medical therapies, nearly all patients seek to understand how diet affects their psoriatic disease,” Adam R. Ford, BS, of the University of Southern California Keck School of Medicine, and colleagues wrote. “Overall, there is a critical lack of evidence synthesis on the relationship between psoriatic diseases and diet. This literature gap speaks to the need for evidence-based dietary recommendations that are accessible to clinicians and patients.”

The National Psoriasis Foundation’s medical board strongly recommends dietary weight loss with a hypocaloric diet for overweight and obese patients with psoriasis, and weakly suggests that overweight or obese patients with PsA both supplement their diet with vitamin D and lose weight.
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To provide evidence-based dietary recommendations for adults with PsA and psoriasis, the National Psoriasis Foundation’s medical board performed a systematic review of literature published from Jan. 1, 2014, to Aug. 31, 2017. Focusing on observational and interventional studies of patients with psoriasis and PsA, the researchers identified 55 papers, representing 77,557 unique patients, that met their inclusion criteria.

The researchers determined the quality of the included observational studies using the Newcastle-Ottawa scale, and the Cochrane Risk of Bias Tool for the interventional studies. Based on the review, members of the medical board voted on each recommendation.

The board issued a strong recommendation for dietary weight loss with a low-calorie diet among overweight and obese patients with psoriasis. In addition, the board weakly recommends a gluten-free diet in patients with serologic markers of gluten sensitivity. Low-quality data suggest select foods, nutrients and dietary patterns may affect psoriasis.

Among patients with PsA, the board weakly recommends vitamin D supplementation and dietary weight reduction with a low-calorie diet in those who are overweight and obese.

In addition, the researchers also highlighted three “concepts” for interpreting their recommendations. First, they stressed the importance of continuing regular medical therapy for psoriatic diseases, and that dietary interventions cannot be the only source of treatment. Second, they noted that dietary interventions can be associated with adverse effects and contraindications. Last, the researchers wrote that their recommendations may have impacts beyond psoriatic disease, and could affect their general health as well.

“Dietary interventions, when implemented, should be used in conjunction with standard medical therapies for psoriatic diseases,” Ford and colleagues wrote. “Based on low-quality data, select foods, nutrients, and dietary patterns may affect psoriasis. For patients with psoriatic arthritis, we weakly recommend vitamin D supplementation and dietary weight reduction with a hypocaloric diet in overweight and obese patients.” – by Jason Laday

Disclosure: Ford reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.