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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.
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.”
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.
Perspective
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Carrie Beach, BSN, RN
Ford and colleagues explore the impact of specific dietary interventions on the severity of disease activity in patients with psoriatic diseases. The researchers reviewed several observational and interventional studies, including interventions such as weight reduction with hypocaloric diet, gluten-free diet, vitamin d supplementation as well as the use of dietary supplements, including fish oil, vitamin D, selenium and vitamin B12.
The strongest recommendation was made for dietary weight reduction by means of a hypocaloric diet among overweight and obese patients with psoriasis. As rheumatology professionals, we know that there is an established link between obesity and psoriasis, as well as other rheumatic diseases. Discussing weight issues with our patients isn’t always easy, but it is essential as it can lead to better control of their disease and overall, better general health.
Gluten has been an increasingly hot topic for discussion in recent years. Interestingly, a gluten-free diet was found to only be beneficial among patients with a confirmed diagnosis of Celiac disease or those who tested positive for the serological markers of gluten insensitivity.
My patients are always looking for something safe and natural that they can do to control their disease; I get numerous questions regarding supplements and dietary changes on a daily basis. Unfortunately, the other reviewed interventions were based on low- or limited-quality evidence and therefore could not be recommended. I think the most important take away from this review is that it is essential to educate our patients regarding supplementation with dietary interventions; while it may lead to a decrease in severity of disease, it should not replace current medical therapies.
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