Ketogenic Diet Intervention Improves Psoriatic Arthritis Symptoms

Credit: Adobe Stock/Yulia Furman

A very low-calorie ketogenic diet (VLCKD) resulted in improvements in skin and joint disease activity, lipid profile, and significant weight loss among overweight patients with psoriatic arthritis (PsA). The 9-week diet intervention was both well-tolerated and effective, although those with higher disease activity at baseline had more minor results regarding weight loss. Additionally, inflammatory markers did not vary significantly after reductions in abdominal circumference and weight loss.¹

Common recommendations for patients with rheumatic diseases include weight loss (for overweight patients) and following a Mediterranean diet plan. A previous study revealed both Mediterranean and ketogenic diets improved disease activity among patients with psoriasis (PsO) and PsA, although most benefits were attributed to the ketogenic diet element.²

The randomized, open-label, controlled crossover trial enrolled 16 patients into the 22-week program, in which patients were divided into 2 cohorts: the ketogenic diet group and the Mediterranean group. Patients followed either diet for 8 weeks before switching to the alternate diet after a 6-week washout period. Those in the ketogenic group reported substantial decreases in interleukin (IL)-6, IL-23, Disease Activity in Psoriatic Arthritis (DAPSA) scores, and Psoriasis Area Severity Index (PASI) scores.²

In the current monocentric study evaluating disease activity and inflammation indices, patients with PsA who were moderately overweight or had first-degree obesity were invited to participate in the short-term VLCKD diet intervention program. The diet was defined as a very restrictive plan, high in fat and low in carbohydrates. Eligible patients were on stable treatment and had stable disease activity according to DAPSA scores in the 6 months prior to baseline and had a body mass index (BMI) between ≥ 27 and < 35. An independent nutritionist evaluated patients every 3 weeks and a rheumatologist assessed results after the trial period.¹

Data included clinical indices, patient-reported outcomes, and anthropometric measurements. Laboratory data collected included IL-1 alpha, IL-1 beta, IL-5, tumor necrosis factor (TNF)-alpha, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fecal calprotectin. Results were presented at the 2024 European Congress of Rheumatology (EULAR) conference.¹

A total of 20 patients were recruited between April 2022 and March 2023. At baseline, the median age was 55.5 years, 50% were male (n = 10), and the median BMI was 30.9. The median DAPSA score was 11.5, the median Visual Analog Scale (VAS) for pain score was 4, and the median Work Productivity and Activity Impairment (WPAI)-impact score was 3.5.¹

At the end of the intervention period, all patients displayed a significant reduction in weight of approximately 3 BMI points. Additionally, patient-reported pain, the impact on working ability, and indices of joint and skin disease activity were significantly decreased by week 9, with additional improvements in insulin levels and the lipid profile. There were no differences noted regarding axial disease measures, enthesitis, or inflammatory markers. Significant associations were reported between BMI reduction and DAPSA reduction, as well as BMI reduction and the impact on working ability, as measured by WPAI scores.¹

Older patients had a lower reduction in abdominal circumference throughout the intervention, while patients with metabolic syndrome were more likely to demonstrate reductions in BMI, weight, and abdominal circumference. Additionally, baseline TNF-alpha levels were linked to a higher probability of BMI reduction and weight loss. Those with higher DAPSA scores at baseline were less likely to exhibit weight loss, abdominal circumference reduction, and BMI reduction.¹

References

1. ^{Ometto F, Striani G, Lorenzin M, Cozzi G, et al. Very Low-Calorie Ketogenic Diet in Patients with Psoriatic Arthritis: A Proof of Concept Study. Presented at: EULAR. Vienna, Austria. June 12 – 15, 2024.}
2. ^{Smith T. Psoriasis, psoriatic arthritis patients benefited from Mediterranean-ketogenic diet program. HCP Live. March 22, 2024. Accessed July 18, 2024. https://www.hcplive.com/view/psoriasis-psoriatic-arthritis-patients-benefited-from-mediterranean-ketogenic-diet-program.}