People with psoriatic arthritis often have obesity, and obesity may worsen the symptoms of psoriatic arthritis. Taking medications and losing weight can improve the symptoms of psoriatic arthritis.

Psoriatic arthritis (PsA) is a form of inflammatory arthritis that involves pain and stiffness in the joints. Without treatment, it can lead to permanent joint damage.

Some statistics suggest that up to 45% of people with PsA have obesity. However, they do not know precisely what links them. Scientists say the relationship is complex and probably bidirectional, meaning PsA and obesity contribute to each other.

There are several reasons why obesity might make the symptoms of PsA worse.

First, they both involve inflammation, and obesity may exacerbate this. Carrying extra weight puts additional pressure on weight-bearing joints, affecting mobility and exercise capacity. Obesity may also stop some PsA medications from working as well as they could.

In this article, we look at the links between PsA and weight, including ways to safely lose weight with PsA.

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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 are overweight also seem to have more severe symptoms and find it harder to manage symptoms.

Carrying extra weight can also put extra pressure on joints, ligaments, and tendons. In turn, painful joints can make it harder to exercise. This can lead to weight gain, which then puts more pressure on the joints, making symptoms worse.

According to the Arthritis Foundation, if people with overweight and arthritis lose 10% of their body weight, they could experience 50% less pain, and their mobility may improve.

The authors of a 2019 study found evidence that inflammation occurs with obesity but not that it predicts the development of obesity.

Some research from 2022 suggested that acute inflammation due to infections may increase the risk of long-term weight gain.

However, studies have not shown a similar effect with other causes of inflammation, such as psoriatic disease.

Fat tissue produces proteins called cytokines, chemokines, and adipokines. These proteins contribute to inflammation. This can add to the inflammation already present with PsA.

Being overweight or having obesity can prevent PsA medications, such as disease-modifying anti-rheumatic drugs (DMARDs) and tumor necrosis factor inhibitors (TNFi) from working effectively.

These treatments aim to minimize disease activity.

According to a 2020 review, good evidence shows that losing weight can improve a person’s response to medication such as DMARDs and TNFi drugs.

The authors refer to findings showing that people who lost 10% or more of their weight saw significantly greater improvements in their response to treatment than those who lost less than 5% of their weight.

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. Previous studies suggested that weight loss may occur when using PDE4 inhibitors.

The scientists followed up with 60 people who took 30 milligrams per day of apremilast. Participants started with an average body mass index (BMI) of 33.2.

On average, they lost 2.2 kilograms, and their BMI fell by 0.8% over 6 months. In addition, there was a reduction in abdominal fat and other fatty tissue. Disease activity fell. However, the extent of the improvement did not correlate to weight loss.

The best way to lose weight is through dietary choices and regular 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
  • have 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 should discuss a suitable exercise plan with their doctor before starting.

Joining a group activity can be motivating and may lead to 20% higher success in managing weight, according to the Arthritis Foundation.

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 AF offers the following steps 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 to 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 — for example, sitting down at the table to eat rather than on the sofa watching television — may help reduce calorie intake by 300 calories per day.

A 2019 study found that short-term weight loss on a very low-energy 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?

Losing excess weight through exercise and diet may help someone with PsA to:

  • ease pain
  • improve mobility
  • decrease inflammation
  • improve their body’s response to medication

Compared with the general population, people with PsA have a higher risk of having metabolic syndrome, which features:

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 general 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.

Can medications help people with psoriatic arthritis lose weight?

There is some evidence that people could lose some weight when using PDE4 inhibitors, such as apremilast, to treat PsA. To manage weight, however, it is best to focus on eating a nutritious diet and getting regular exercise when possible.

Does losing weight improve symptoms of psoriatic arthritis?

There is evidence that losing weight improves 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 symptoms improved.

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

One reason for this may be that obesity can contribute to inflammation. The extra weight can also put extra pressure on the joints, worsening the symptoms of pain and stiffness. This, in turn, can make exercise more challenging, increasing the risk of weight gain.

Obesity may also affect the way some PsA medications affect a person. DMARDs and TNFi 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 an individual’s overall health and well-being. Dietary choices and exercise can help achieve this.

Anyone considering changes to their diet and exercise routine should first speak with a healthcare professional, who will help them make a suitable treatment plan.