Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor α blockers

Matteo Nicola Dario Di Minno, Rosario Peluso, Salvatore Iervolino, Anna Russolillo, Roberta Lupoli, Raffaele Scarpa, CaRRDs Study Group, Matteo Nicola Dario Di Minno, Anna Russolillo, Alessandro Di Minno, Giovanni Tarantino, Giovanni Di Minno, Rosario Peluso, Raffaele Scarpa, Paolo Osvaldo Rubba, Salvatore Iervolino, Matteo Nicola Dario Di Minno, Rosario Peluso, Salvatore Iervolino, Anna Russolillo, Roberta Lupoli, Raffaele Scarpa, CaRRDs Study Group, Matteo Nicola Dario Di Minno, Anna Russolillo, Alessandro Di Minno, Giovanni Tarantino, Giovanni Di Minno, Rosario Peluso, Raffaele Scarpa, Paolo Osvaldo Rubba, Salvatore Iervolino

Abstract

Objectives: To evaluate prospectively the effect of weight loss on the achievement of minimal disease activity (MDA) in overweight/obese patients with psoriatic arthritis (PsA) starting treatment with tumour necrosis factor α (TNFα) blockers.

Methods: Among subjects with PsA starting treatment with TNFα blockers, 138 overweight/obese patients received a concomitant dietary intervention (69 a hypocaloric diet (HD) and 69 a free-managed diet (FD)). Changes in metabolic variables were measured and a complete clinical rheumatological evaluation was made in all patients at baseline and after a 6-month follow-up to define the achievement of MDA.

Results: 126 subjects completed the study. MDA was more often achieved by HD than by FD subjects (HR=1.85, 95% CI 1.019 to 3.345, p=0.043). A diet was successful (≥5% weight loss) in 74 (58.7%) patients. Regardless of the type of diet, after 6 months of treatment with TNFα blockers, ≥5% of weight loss was a predictor of the achievement of MDA (OR=4.20, 95% CI 1.82 to 9.66, p<0.001). For increasing weight-loss categories (<5%, 5-10%, >10%), MDA was achieved by 23.1%, 44.8% and 59.5%, respectively. A higher rate of MDA achievement was found in subjects with 5-10% (OR=3.75, 95% CI 1.36 to 10.36, p=0.011) and in those with >10% (OR=6.67, 95% CI 2.41 to 18.41, p<0.001) weight loss in comparison with those with <5% weight loss.

Conclusions: Regardless of the type of diet, a successful weight loss (≥5% from baseline values) is associated with a higher rate of achievement of MDA in overweight/obese patients with PsA who start treatment with TNFα blockers.

Keywords: Disease Activity; Psoriatic Arthritis; TNF-alpha.

Figures

Figure 1
Figure 1
Changes in rheumatological clinical outcome measures from baseline (T0) to the 6-month (T1) visit. p Values are for paired sample t test; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; HAQ, Health Assessment Questionnaire; PASI, Psoriasis Area Severity Index; SJC, swollen joint count; TEC, tender entheseal count; TJC, tender joint count; VAS, Visual Analogue Scale for pain. VAS and global VAS are reported in centimetres in this figure.
Figure 2
Figure 2
MDA achievement according to categories of weight loss changes during the 6 months’ follow-up. MDA, minimal disease activity.

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Source: PubMed

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