The Impact of Intermittent Fasting (Ramadan Fasting) on Psoriatic Arthritis Disease Activity, Enthesitis, and Dactylitis: A Multicentre Study

Mohammad Adawi, Giovanni Damiani, Nicola Luigi Bragazzi, Charlie Bridgewood, Alessia Pacifico, Rosalynn R Z Conic, Aldo Morrone, Piergiorgio Malagoli, Paolo Daniele Maria Pigatto, Howard Amital, Dennis McGonagle, Abdulla Watad, Mohammad Adawi, Giovanni Damiani, Nicola Luigi Bragazzi, Charlie Bridgewood, Alessia Pacifico, Rosalynn R Z Conic, Aldo Morrone, Piergiorgio Malagoli, Paolo Daniele Maria Pigatto, Howard Amital, Dennis McGonagle, Abdulla Watad

Abstract

Intermittent circadian fasting, namely Ramadan, is a common worldwide practice. Such fasting has a positive impact on psoriasis, but no data exist on its role in psoriatic arthritis (PsA)-a disease that is clearly linked to body mass index. We enrolled 37 patients (23 females and 14 males) with a mean age 43.32 ± 7.81 and they fasted for 17 h for one month in 2016. The baseline PsA characteristics were collected and 12 (32.4%) patients had peripheral arthritis, 13 (35.1%) had axial involvement, 24 (64.9%) had enthesitis, and 13 (35.1%) had dactylitis. Three patients (8.1%) were treated with methotrexate, 28 (75.7%) with TNF-α blockers, and 6 (16.2%) with IL-17 blockers. After a month of intermittent fasting, C-reactive protein (CRP) levels decreased from 14.08 ± 4.65 to 12.16 ± 4.46 (p < 0.0001), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) decreased from 2.83 ± 1.03 to 2.08 ± 0.67 (p = 0.0078), Psoriasis Area Severity Index (PASI) decreased from 7.46 ± 2.43 to 5.86 ± 2.37 (p < 0.0001), and Disease Activity index for PSoriatic Arthritis (DAPSA) decreased from 28.11 ± 4.51 to 25.76 ± 4.48 (p < 0.0001). Similarly, enthesitis improved after fasting, with Leeds Enthesitis Index (LEI) decreasing from 2.25 ± 1.11 to 1.71 ± 0.86 (p < 0.0001) and dactylitis severity score (DSS) decreasing from 9.92 ± 2.93 to 8.54 ± 2.79 (p = 0.0001). Fasting was found to be a predictor of a decrease in PsA disease activity scores (DAPSA, BASDAI, LEI, DSS) even after adjustment for weight loss. IL-17 therapy was found to be an independent predictor of decreases in LEI after fasting. These preliminary data may support the use of chronomedicine in the context of rheumatic diseases, namely PsA. Further studies are needed to support our findings.

Keywords: chronomedicine; circadian rhythm and biological clock; intermittent fasting; psoriatic arthritis.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Change in C-reactive protein (CRP) levels after intermittent fasting.
Figure 2
Figure 2
Change in Disease Activity Index for PSoriatic Arthritis (DAPSA) score after intermittent fasting.
Figure 3
Figure 3
Change in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score after intermittent fasting.
Figure 4
Figure 4
Change in Psoriasis Area Severity Index (PASI) after intermittent fasting.
Figure 5
Figure 5
Change in Leeds Enthesitis Index after intermittent fasting.
Figure 6
Figure 6
Change in the Dactylitis Severity Score (DSS) after intermittent fasting.

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