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Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis FoundationA Systematic Review

Educational Objective
To understand the evidence-based dietary recommendations for adults with psoriasis and psoriatic arthritis.
1 Credit CME
Key Points

Question  What dietary interventions help adult patients with psoriasis and/or psoriatic arthritis reduce their disease severity?

Findings  In this systematic review of 55 studies and 4534 patients with psoriasis, we identify the strongest evidence for dietary weight reduction with a hypocaloric diet in overweight and obese patients with psoriasis. The utility of gluten-free diet and supplementation with vitamin D varies by subpopulations of adults with psoriatic diseases, and evidence is low for the utility of specific foods, nutrients, and dietary patterns in reducing psoriatic disease activity.

Meaning  Adults with psoriasis and/or psoriatic arthritis can supplement their medical therapies with dietary interventions to reduce disease severity.

Abstract

Importance  Psoriasis is a chronic, inflammatory skin disease and has significant associated morbidity and effect on quality of life. It is important to determine whether dietary interventions help reduce disease severity in patients with psoriatic diseases.

Objective  To make evidence-based dietary recommendations for adults with psoriasis and/or psoriatic arthritis from the Medical Board of the National Psoriasis Foundation.

Evidence Review  We used literature from prior systematic reviews as well as additional primary literature from the MEDLINE database from January 1, 2014, to August 31, 2017, that evaluated the impact of diet on psoriasis. We included observational and interventional studies of patients with psoriasis or psoriatic arthritis. The quality of included studies was assessed using the Newcastle-Ottawa scale for observational studies and the Cochrane Risk of Bias Tool for interventional studies. We made evidence-based dietary recommendations, which were voted on by the National Psoriasis Foundation Medical Board.

Findings  We identified 55 studies meeting the inclusion criteria for this review. These studies represent 77 557 unique participants of which 4534 have psoriasis. Based on the literature, we strongly recommend dietary weight reduction with a hypocaloric diet in overweight and obese patients with psoriasis. We weakly recommend a gluten-free diet only in patients who test positive for serologic markers of gluten sensitivity. Based on low-quality data, select foods, nutrients, and dietary patterns may affect psoriasis. For patients with psoriatic arthritis, we weakly recommend vitamin D supplementation and dietary weight reduction with a hypocaloric diet in overweight and obese patients. Dietary interventions should always be used in conjunction with standard medical therapies for psoriasis and psoriatic arthritis.

Conclusions and Relevance  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.

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Article Information

Accepted for Publication: April 10, 2018.

Corresponding Author: April W. Armstrong, MD, MPH, Department of Dermatology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, KAM 510, MC 9034, Los Angeles, CA 90089 (armstrongpublication@gmail.com).

Published Online: June 20, 2018. doi:10.1001/jamadermatol.2018.1412

Author Contributions: Mr Ford and Dr Armstrong had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Ford, Armstrong.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Ford, Armstrong.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Ford, Armstrong.

Administrative, technical, or material support: Ford, Armstrong.

Study supervision: Ford, Armstrong.

Conflict of Interest Disclosures: Dr M. Siegel is employed by the National Psoriasis Foundation; the Foundation receives unrestricted financial support from AbbVie Inc, Amgen Inc, Celgene Corporation, Eli Lilly and Co, Janssen Biotech Inc, LEO Pharma Inc, Mallinckrodt Pharmaceuticals, Novartis Pharmaceuticals, Pfizer Inc, and Valeant Pharmaceuticals International, Inc. Dr Bagel serves as an investigator, speaker, and consultant for AbbVie, Janssen, Eli Lilly, Novartis, and Celgene; an investigator and speaker for Leo and Regeneron; and an investigator for Kadmow and Dermira. Dr Cordoro serves as a consultant for Celgene. Dr Garg serves as an advisor for AbbVie, Pfizer, Asana, and Janssen; he conducts research for AbbVie, Merck, and UCB. Dr Gottlieb does consulting and/or is on the advisory board for Janssen, Celgene, Bristol-Myers Squibb, Beiersdorf, AbbVie, UCB, Novartis, Incyte, Lilly, Reddy Labs, Valeant, Dermira, Allergan, and Sun Pharmaceutical Industries; she receives research grants from Janssen and Incyte. Dr Green serves as a consultant, investigator, and/or speaker for Amgen, AbbVie, Celgene, Leo, SunPharma, and Ortho-Dermatologics. Dr Gudjonsson receives research grants from Genentech, Amgen, AbbVie, Pfizer, and Novartis; he is on the advisory board for Novartis and serves as a consultant for MiRagen. Dr Koo serves as a speaker and/or is on the advisory board for Janssen, Novartis, AbbVie, Celgene, Regeneron, Sanofi, Eli Lilly, and Leo. Dr Lebwohl is an employee of Mount Sinai and receives research funds from AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Incyte, Janssen/Johnson & Johnson, Leo Pharmaceuticals, Medimmune/Astra Zeneca, Novartis, Pfizer, Sciderm, Valeant, and ViDac; he is a consultant for Allergan, Aqua, Leo Pharmaceuticals, and Dr Reddy’s Laboratories. Dr Mandelin is on the advisory board for Horizon and the speakers’ bureau for Abbott/AbbVie, Genentech, Pfizer, Sanofi/Genzyme, and UCB; he serves as a speaker for American Medical Forum and Catmed. Dr Markenson is on the advisory board for Merck, Lilly, Novartis, Calgene, Flexion, and GSK and is on the speakers’ bureau for Abbvie, Regeneron, Lilly, Novartis, Bristol-Myers Squibb, Pfizer, Janssen, Calgene, and Flexion. Dr Merola serves as a consultant for Biogen IDEC, AbbVie, Eli Lilly, Novartis, Pfizer, Janssen, UCB, Samumed, Science 37, Celgene, Sanofi Regeneron, Merck and GSK; a speaker for Abbvie; an investigator for Biogen IDEC, Pfizer, Sanofi Regeneron, Incyte, and Novartis; and a licensed outcome measure to AbbVie and Lilly. Dr Prussick serves as a speaker for AbbVie, Janssen, Celgene, and Pfizer; he performs studies for Novartis and is on the medical board for Immunotec. Dr Ryan serves as a consultant, speaker, and/or advisor for AbbVie, Boehringer Ingelheim, Eli Lilly, Novartis, Dr Reddy’s, Dermira, Leo, and Janssen. Dr Schwartzman serves as a consultant for AbbVie, Crescendo, Dermtech, Genetech, Gilead, Janssen, Lilly, Myriad, Novartis, Pfizer, Regeneron, Sanofi, and UCB and as a speaker for Abbvie, Genetech, Janssen, Lilly, Novartis, Pfizer, Regeneron, Sanofi, UCB, and Genentech. He is on the scientific advisory board for Crescendo, Myriad, and Dermtech; is a board member for Discus Analytics and the National Psoriasis Foundation; and has stock ownership in Amgen, Boston Scientific, Gilead, and Medtronic. Dr E. L. Siegel serves as a consultant for AbbVie, Lilly, Janssen, Novartis, Bristol-Myers Squibb, Celgene, and Sanofi/Regeneron; he is on the speakers’ bureau for AbbVie, Amgen, Lilly, and Novartis and performs research support for AbbVie, Amgen, and Bristol-Myers Squibb. Dr Van Voorhees is on the advisory board for Dermira, Novartis, Allergan, Celgene, Derm Tech, Valeant, WebMD, Pfizer, Merck, Amgen, Janssen, Aqua, Leo, and Lilly; she does consulting for Dermira, Novartis, Celgene, AbbVie, and Astra Zeneca. Dr Wu serves as an investigator for AbbVie, Amgen, Eli Lilly, Janssen, Novartis, and Regeneron. Dr Armstrong serves as an investigator, consultant, advisor, and/or speaker to AbbVie, Janssen, Lilly, Novartis, Sanofi, Regeneron, Leo, Science 37, Modmed, Pfizer, Ortho Dermatologics, and Modernizing Medicine. No other disclosures are reported.

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