Psoriatic Arthritis & the Obese Patient

“We do know that adipocytes produce inflammatory cytokines, which may increase the obese patient’s joint inflammation,” says Dr. Ogdie. “In addition, giving every patient with PsA the same 40 mg dose of adalimumab regardless of their weight really doesn’t make sense, but that’s what the original study suggests. It’s just one dose for everybody. So patients not getting the appropriate dose for their body weight may also play a role.”⁷

Additional challenges to treatment include “the typical lifestyle habits that go along with having a chronic disease,” says Dr. Husni. These may include poor sleep, inability to exercise and a worsened response to stress, all of which can be more pronounced when dealing with a chronic illness.

“Given the evidence now, we have shifted our attitude; improvements in our lifestyle behaviors are important and not likely something that is optional,” Dr. Husni says. “We encourage our patients to discuss how to modify their lifestyle behaviors when they have a chronic illness. These ‘wellness strategies’ may not be a luxury, but rather, a critical adjunctive concern that needs to be addressed. They are just as important as treating the disease.”

Stressing that lifestyle changes are intertwined with psychosocial health, she advocates for a whole-patient approach, which she feels is especially key for obese patients, whose condition is frequently misunderstood.

“It’s easy for us to dismiss people who are obese and think they don’t care about themselves or that they choose not to change their habits,” Dr. Husni says. “However, there are different stages of treating obesity now. We have a greater understanding of the hormones related to obesity, such as ghrelin and leptin, and how they can become dysregulated to result in a higher weight set point.”

Dr. Husni

At the Cleveland Clinic, Dr. Husni can refer patients with more urgent weight-related needs to the clinic’s Endocrine and Metabolic Institute for care. Dr. Ogdie reports that Penn is currently running a diet trial for patients with a BMI of 25–40. The focus, she explains, is on lifestyle changes over monitoring weight, although both are in the mix. She has referred her patients to the study.

Dietary guidance, although helpful, should be just part of a broader treatment plan for obese patients with PsA, say both rheumatologists. “It’s important that we understand all the different comorbidities of psoriatic arthritis, obesity being one of them. And if obesity affects your patient, you need to look around and see what resources you can use to build a team to address it,” says Dr. Husni.