Does weight loss reduce the severity and incidence of psoriasis or psoriatic arthritis? A critically‐appraised topic

Abstract

Clinical question

Does weight loss reduce the severity and incidence of psoriasis or psoriatic arthritis (PsA) in obese individuals?

Background

Obesity presents a rising public health challenge and is more prevalent amongst individuals with psoriasis or PsA compared to the general population. Longitudinal population‐based studies suggest a causal role for obesity in psoriasis and PsA onset and that obesity drives greater disease severity.

Methods

We systematically reviewed evidence within Medline/EMBASE/CENTRAL databases and clinical trials registries examining lifestyle, pharmacological and surgical weight loss interventions in the treatment and prevention of psoriasis and PsA in obese individuals. Meta‐analysis was conducted using random effects models, followed by sensitivity analyses.

Results

Of 176 full‐text articles reviewed, 14 met the inclusion criteria. Meta‐analysis of six randomised control trials (RCTs) confirmed that weight loss following lifestyle interventions (diet/physical activity) improves psoriasis compared to control (mean change in psoriasis area and severity index ‐2·59; 95%CI ‐4·09, ‐1·09; p<0·001). One RCT demonstrated a greater likelihood of achieving minimal PsA activity following diet‐induced weight loss (odds ratio 4·20; 95%CI 1·82‐9·66; p<0·001). Three studies of pharmacological treatments reported conflicting results and no RCTs of bariatric surgery were identified. Two cohort studies suggested bariatric surgery, particularly gastric bypass, reduces the risk of developing psoriasis (hazard ratio 0·52; 95%CI 0·33‐0·81; p<0·01).

Discussion/recommendation

These limited data indicate that weight loss can improve pre‐existing psoriasis and PsA, and prevent the onset of psoriasis in obese individuals. Together with NICE obesity guidance, this informed a local obesity screening and management pathway, providing multi‐disciplinary weight loss interventions alongside conventional skin‐focused care for psoriasis.

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