PsA and Nutrition

Nutrition

It is estimated that one third of psoriasis patients suffer from psoriatic arthritis (PsA), which involves swelling of the joints (e.g., knees, elbows, hand joints) as well as the skin symptoms associated with psoriasis.1,2. While nutrition is not a medical treatment of PsA, it may help lower and/or control your symptoms when paired with your medication. As PsA is often associated with other conditions such as obesity, diabetes and cardiovascular diseases, maintaining healthy food habits can only be beneficial for your general well-being and physical state2,3. 

To help control joint swelling and other associated symptoms, here are some recommended anti-inflammatory foods to include in your diet: 

  • Fruits and vegetables, especially green vegetables
  • Beans, whole grains 
  • Nuts
  • Olive oil
  • Fatty acids (e.g., fish, avocado, seed oils, etc.) that are rich in omega-3 acids 
  • Specific anti-inflammatory spices (e.g., garlic, ginger, cinnamon, cayenne)
  • Green tea 

Foods to avoid 

It is important to highlight that some nutrients can worsen your joint pain and inflammation.. Since PsA is a progressive inflammatory disease, it is recommended that you to avoid consuming high-inflammatory foods on a regular basis:  

  • Alcohol 
  • Processed foods (trans fat) and refined carbohydrates (e.g., white bread, pastries, desserts) 
  • Processed meat (e.g., sausage, pepperoni) and red meat (saturated fat) 
  • Fried foods (trans fat) 

Dietary supplements 

In PsA, some dietary supplements may help improve or control your symptoms when taken with your standard medication. For instance, some studies have found that a weekly intake of vitamin D may help with PsA symptoms4,5. However, it is important to consult your doctor before starting to take any supplements as it could interfere with your medical therapies or not be beneficial at all. Some dietary supplements are not recommended due to a lack of evidence and/or results such as fish oil and selenium supplements4. 

Special diets 

The scientific literature suggests that weight-loss can help control disease severity for overweight and obese PsA patients4,6,7. A recent study found that a 5-10% weight reduction in overweight and obese patients could help achieve minimal disease activity6. It is also known that obesity is associated with an increase of PsA disease activity2,8. Interestingly, body composition could also influence PsA activity. Patients with more lean mass (a lower percentage of body fat) were found to have fewer joint symptoms compared to patients with a higher fat mass (higher percentage of body fat) proportion2. 

Despite few studies on the topic, the Mediterranean diet could be a promising approach to reduce inflammation associated with PsA9. This diet includes most of the above-mentioned healthy foods (fruits and vegetables, whole-grain cereals, fish, olive oil) which all have anti-inflammatory and antioxidant properties. Similarly, despite few studies being available, intermittent fasting on its own could potentially contribute to reducing PsA activity by lowering proinflammatory mechanisms10. 

Written by: Maxine Joly-Chevrier, July 2022

Medically Reviewed by Dr. Vinod Chandran

RÉFÉRENCES
  1.   Gladman DD. Psoriatic arthritis. Moderate-to-Severe Psoriasis, Third Edition. 2008;8:239-258. doi:10.12688/F1000RESEARCH.19144.1/DOI
  2.  Leite BF, Morimoto MA, Gomes CMF, et al. Dietetic intervention in psoriatic arthritis: the DIETA trial. Adv Rheumatol. 2022;62(1). doi:10.1186/S42358-022-00243-6
  3. Haddad A, Zisman D. Comorbidities in Patients with Psoriatic Arthritis. Rambam Maimonides Medical Journal. 2017;8(1):e0004. doi:10.5041/RMMJ.10279
  4.  Ford AR, Siegel M, Bagel J, et al. Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review. JAMA Dermatol. 2018;154(8):934-950. doi:10.1001/JAMADERMATOL.2018.1412
  5.    Huckins D, Felson DT, Holick M. Treatment of psoriatic arthritis with oral 1,25-dihydroxyvitamin D3: a pilot study. Arthritis Rheum. 1990;33(11):1723-1727. doi:10.1002/ART.1780331117
  6.   di Minno MND, Peluso R, Iervolino S, Russolillo A, Lupoli R, Scarpa R. Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor α blockers. Annals of the Rheumatic Diseases. 2014;73(6):1157-1162. doi:10.1136/ANNRHEUMDIS-2012-202812
  7.  Abou-Raya A, Abou-Raya S, Helmii M. OP0076 Effect of Exercise and Dietary Weight Loss on Symptoms and Systemic Inflammation in Obese Adults with Psoriatic Arthritis: Randomized Controlled Trial. Annals of the Rheumatic Diseases. 2014;73(Suppl 2):89-90. doi:10.1136/ANNRHEUMDIS-2014-EULAR.2760
  8.  Kumthekar A, Ogdie A. Obesity and Psoriatic Arthritis: A Narrative Review. Rheumatology and Therapy. 2020;7(3):447. doi:10.1007/S40744-020-00215-6
  9. Caso F, Navarini L, Carubbi F, et al. Mediterranean diet and Psoriatic Arthritis activity: a multicenter cross-sectional study. Rheumatol Int. 2020;40(6):951-958. doi:10.1007/S00296-019-04458-7
  10. Adawi M, Damiani G, Bragazzi NL, et al. The Impact of Intermittent Fasting (Ramadan Fasting) on Psoriatic Arthritis Disease Activity, Enthesitis, and Dactylitis: A Multicentre Study. Nutrients 2019, Vol 11, Page 601. 2019;11(3):601. doi:10.3390/NU11030601