What to know about psoriatic arthritis and weight gain

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Experts say there is a link between obesity and PsA. What links them remains unclear. However, obesity appears to be a risk factor for PsA.

People with overweight or obesity appear to have a higher risk of developing psoriasis and PsA. People living with PsA who have overweight also seem to have more severe PsA symptoms and find it harder to manage them.

Overweight and obesity can also pressure joints, ligaments, and tendons. In turn, painful joints can make it harder to get physical activity. This can lead to weight gain, which puts more pressure on the joints, making symptoms worse.

It is not clear that PsA inflammation causes weight gain. Research from 2022 suggests that acute inflammation from infections may increase the risk of long-term weight gain, but studies have not shown a similar effect in psoriatic diseases.

Overweight and obesity can prevent PsA medications, such as disease-modifying antirheumatic drugs (DMARDs) and tumor necrosis factor (TNF) inhibitors, from working effectively.

These treatments aim to minimize disease activity.

According to a 2020 review of research, good evidence shows losing weight can improve the body’s response to medication, such as DMARDs and TNF inhibitors.

Research published in 2022 found that apremilast (Otezla) may help manage weight, symptoms, and complications in people with psoriatic disease, including PsA.

Apremilast is a type of drug known as a small molecule phosphodiesterase 4 (PDE4) inhibitor.

The best way to lose weight is through sustainable dietary choices and regular exercise.

Exercise

Physical activity can help manage weight and keep a person mobile. The American College of Rheumatology notes that people with arthritis who exercise regularly may have:

• less pain
• higher energy levels
• better quality sleep
• better daily functioning

Current guidelines recommend low impact exercises, such as swimming, tai chi, or yoga, for people with PsA. People can discuss a suitable exercise plan with their doctor before starting.

What is a good exercise plan for people with PsA?

Dietary choices

Eating a varied, balanced, and nutritious diet is also essential for weight management.

The Arthritis Foundation offers the following tips for losing weight:

• Nutritious food: Focus on whole foods, including fruits, vegetables, fish, nuts, and beans, and limit highly processed foods.
• Portion size: Using a smaller dish may reduce how much a person eats by as much as 20%.
• Staying hydrated: Drinking water before a meal can help people feel fuller quicker.
• Sleep: A lack of sleep can slow the body’s production of leptin, a protein that makes people feel full. It also increases the body’s production of ghrelin, a hormone that drives hunger.
• Eating mindfully: Eating more slowly and mindfully may help reduce calorie intake by 300 calories per day. For example, a person can sit at a table to eat rather than on the sofa watching television.

A 2019 study found that short-term weight loss on a very low calorie diet improved symptoms of PsA. However, people should not try this or other significant dietary changes without first discussing it with a doctor.

What is a suitable diet for people with PsA?

For a person with PsA and overweight or obesity, losing weight through diet and exercise may help:

• ease pain
• improve mobility
• decrease inflammation
• improve the body’s response to medication
• decrease the risk of cardiovascular disease

Managing weight can help reduce the risk of these potentially serious complications.

Here are some questions people often ask about psoriatic arthritis and body weight.

Does obesity cause psoriatic arthritis?

The rate of obesity is higher in people with PsA than in the larger population. However, it is not clear whether obesity results from or contributes to PsA. Experts say the relationship is complex, and the two conditions likely contribute to each other.

Does psoriatic arthritis make it harder to lose weight?

Arthritis inflammation and pain can make many activities more difficult, affecting how easily a person can lose weight. Another common symptom of PsA that may reduce activity levels is fatigue.

While PsA can make it harder to lose weight, it is still possible.

Can medications help people with psoriatic arthritis lose weight?

Optimal management of inflammation, such as that experienced with PsA, can aid weight management or loss. For example, there is some evidence that people could lose some weight when using PDE4 inhibitors, a type of PsA medication.

Does losing weight improve symptoms of psoriatic arthritis?

Losing weight improves PsA symptoms and reduces the risk of cardiovascular disease and other complications of PsA.

People with obesity and PsA who have lost 10% or more of their weight have seen significant reductions in disease activity and improved symptoms.

There appears to be a link between psoriatic disease, including PsA, and obesity.

One reason may be that obesity can contribute to inflammation. Obesity may also affect the way some PsA medications affect the body. DMARDs and TNF inhibitor drugs appear to work more effectively when people with obesity lose weight.

Maintaining a moderate weight may help manage the symptoms of PsA and boost a person’s overall health and well-being. Dietary choices and exercise can help achieve this.