Psoriatic Disease and Lifestyle: 3 New Things

Aug 28, 2018

Here: the impact of vitamin D, the Mediterranean diet, and psychological stress on disease severity.

References1. 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;154:934-950. doi: 10.1001/jamadermatol.2018.1412.2. Phan C, Touvier M, Kesse-Guyot E, et al. Association between Mediterranean anti-inflammatory dietary profile and severity of psoriasis: results from the NutriNet-SantÃ© Cohort. JAMA Dermatol. 2018 Jul 25. doi: 10.1001/jamadermatol.2018.2127.3. Snast I, Reiter O, Atzmony L, et al. Psychological stress and psoriasis: a systematic review and meta-analysis. Br J Dermatol. 2018;178:1044-1055. doi: 10.1111/bjd.16116.

Lifestyle changes, particularly dietary adjustments, may help ease symptoms in patients with psoriasis, including those with severe disease. The highlights of three new lifestyle-related studies include: (1) some dietary changes may lessen the severity of psoriasis and psoriatic arthritis; (2) the Mediterranean diet may slow progression of psoriasis; and (3) a comprehensive overview of the literature does not link psychological stress with exacerbation and onset of psoriasis.^1-3 Scroll through the slides for the latest findings and their clinical implications.

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A systematic review of 55 studies and 4534 patients with psoriasis-as well as additional primary literature from the MEDLINE database from January 1, 2014, to August 31, 2017-was used to evaluate the impact of diet on psoriatic disease.¹

The Medical Board of the National Psoriasis Foundation found strong evidence to recommend a hypocaloric diet for overweight and obese patients with psoriasis. The board stated there is weak evidence to support a gluten-free diet trial for 3 months, but only in patients with a positive blood test for gluten sensitivity.

For patients with psoriatic arthritis, the board gave a weak recommendation for adding vitamin D and a hypocaloric diet in overweight and obese patients. The board recommends a trial of daily oral vitamin D supplements in addition to standard medical therapies.

Clinical Implications: “Adults with psoriasis and/or psoriatic arthritis can supplement their standard medical therapies with dietary interventions to reduce disease severity. These dietary recommendations from the National Psoriasis Foundation Medical Board will help guide clinicians regarding the utility of dietary interventions in adults with psoriatic diseases,” stated the researchers at the Keck School of Medicine at the University of Southern California in Los Angeles.

A prospective, web-based questionnaire study included 35,735 respondents; 3557 had psoriasis and 878 had severe disease. The dietary practices of the respondents were assessed using a MEDI-LITE score ranging from 0 (no adherence) to 18 (maximum adherence).²

After adjustment for confounding factors, a significant inverse relationship was found between the MEDI-LITE score and severe psoriasis. Patients with severe psoriasis displayed low levels of adherence to the Mediterranean diet.

Clinical Implications: “This finding supports the hypothesis that the Mediterranean diet may slow the progression of psoriasis. If these findings are confirmed, adherence to a Mediterranean diet should be integrated into the routine management of moderate to severe psoriasis,” stated the researchers, led by Dr. CÃ©line Phan of the HÃ´pital Mondor in CrÃ©teil, France.

A systematic review and meta-analysis included 39 studies and 32,537 patients. The studies included 19 surveys, 7 cross-sectional studies, 12 case-control studies and 1 cohort study. Among the patients, 46% believed their disease was stress reactive and 54% recalled preceding stressful events.³

The only study that evaluated a documented stress disorder diagnosis reported similar rates between patients and controls. Four studies that evaluated stressful events prior to psoriasis exacerbation reported comparable rates with controls, whereas two found more frequent/severe preceding events among patients with psoriasis. A small prospective cohort study reported a modest association between stress levels and exacerbation of psoriasis.

Clinical Implications: “From a therapeutic aspect, patients with psoriasis should be carefully assessed for known trigger factors before attributing disease exacerbation and onset to psychological stress,” stated the researchers, led by senior author Lev Pavlovsky, of Beilinson Hospital at the Rabin Medical Center in Petach Tikva, Israel.