Maintaining a healthy weight plays an important role in managing an inflammatory condition like psoriatic arthritis. Overweight and obesity have been linked to an increased risk of psoriatic arthritis. What’s more, carrying around excess weight makes it more difficult to manage this joint condition.
Why? Obesity is thought to cause low-grade inflammation, as fat tissue churns out inflammatory proteins, including cytokines, chemokines, and adipokines. Excess weight also puts more pressure on your joints, which can lead to injury and inflammation. Being overweight can also interfere with medications that treat psoriatic arthritis, so they don’t work as well. Joint guidelines from the American College of Rheumatology and National Psoriasis Foundation (NPF) recommend weight loss for all obese people who have psoriatic arthritis to help improve their response to medication.
The link between obesity and psoriatic arthritis is “very complex and not adequately understood,” says John Davis III, MD, a clinical rheumatologist who specializes in psoriatic arthritis at Mayo Clinic in Rochester, Minnesota. “We believe that [obesity] drives inflammation, providing the link to the joint disease.”
Psoriatic arthritis is also linked to other health conditions, such as heart disease, diabetes, and metabolic syndrome. For all these, “losing weight and maintaining weight in a healthy range is important,” says Melissa Ann Prest, RDN, a spokesperson for the Academy of Nutrition and Dietetics.
The good news: Weight loss has been linked to an improvement in psoriatic arthritis symptoms, including painful swollen joints and fatigue. “It’s probably reducing the inflammatory burden,” says Dr. Davis.
And weight loss doesn’t have to be major. If you’re overweight or obese, losing just 5 to 10 percent of your body weight can lead to improvements in your joint health. The more you lose, the more benefits you’ll gain. Here are some tips to help you lose weight and improve your symptoms.
1. Cut Back on Inflammatory Foods
Davis’s No. 1 tip for people who have psoriatic arthritis and want to lose weight is to eliminate added sugars. These extra calories don’t benefit your body and can increase chronic inflammation, upping your risk of related conditions, such as obesity and diabetes.
Another reason to cut back on sugar: A review of research found that people who have psoriatic arthritis are significantly more likely to have type 2 diabetes than the general population, possibly because inflammation of the skin and joints may affect glucose metabolism. Davis recommends limiting simple sugars and carbohydrates in your diet. “Sugar hides in processed foods, cereal, yogurts, and juices,” he says.
Highly processed foods that often contain added sugars and unhealthy fats
Fatty cuts of meat
Fried foods
Some full-fat dairy products
2. Fill Up on Anti-Inflammatory Foods
Eating plenty of fruits and vegetables can help you lose weight by keeping you full and satisfied on fewer calories.
A plant-based diet can also help decrease inflammation levels, which may reduce psoriatic arthritis symptoms, says Rajat Bhatt, MD, a rheumatologist at Prime Rheumatology in Texas. He specifically recommends the Mediterranean diet, which is rich in anti-inflammatory omega-3 fatty acids. According to Cleveland Clinic, a Mediterranean diet consists of:
3 or more servings of vegetables a day
3 servings of fruit a day
1 to 4 tablespoons of extra-virgin olive oil a day
3 servings of legumes per week
3 servings of nuts per week
3 servings of fish or seafood per week
“Make vegetables the star of your meal by filling half your plate with nonstarchy vegetables, and go with a serving of fruit or a serving of a vegetable for snacks,” recommends Prest.
3. Drink More Water
It’s easy to confuse thirst for hunger, so be sure to drink enough water to help with your weight loss efforts. About eight 8-ounce glasses per day is a good goal, according to Mayo Clinic. You’ll know you’re hydrated if your urine is clear to light yellow.
4. Incorporate Low-Impact Exercise
Although psoriatic arthritis symptoms such as fatigue and stiff, achy joints may make it more challenging to exercise, physical activity can reduce inflammation and pain. “Exercise can increase range of motion in the joints and maintain joint flexibility and muscle strength,” says Dr. Bhatt. Physical activity also increases pain tolerance, helping psoriatic arthritis symptoms feel less debilitating, and decreases uric acid, which reduces joint pain in people who also have gout, he adds.
Staying physically active is especially important for people who have psoriatic arthritis, as metabolic syndrome has been linked to psoriatic arthritis disease activity and medication effectiveness, says Bhatt. Research has found an association between psoriatic arthritis disease severity and an increased frequency of metabolic syndrome factors, which include abdominal obesity, hypertension, and hyperglycemia. Studies show that physical activity can help you tackle metabolic syndrome, improving quality of life, insulin sensitivity, aiding with weight loss, and resulting in better body composition.
As part of a weight loss plan, aim for at least 150 minutes of moderate physical activity per week. “Exercise is great for your overall health and to break through those weight loss plateaus,” says Prest.
If you’re experiencing a lot of joint pain in your lower extremities, Bhatt recommends swimming a few laps. “Swimming is a good low-impact activity for those who have access to a pool and enjoy it,” says Davis.
5. Use a Fitness Tracker to Count Your Steps
Walking is a great weight loss exercise for people with psoriatic arthritis, says Davis. “Maintaining daily activity and step counts [helps] to increase metabolism,” he says. When combined with dietary changes, walking supports weight loss. Walking can also be especially important for weight loss maintenance.
A study suggests that weight-bearing aerobic exercises, such as walking, may help reduce the risk of bone loss. That’s important, as research suggests that psoriatic arthritis treatments may increase the risk of osteoporosis.
If you need extra motivation, use a fitness tracker to track your steps. Set small, manageable goals that slightly challenge you. And listen to your body: It’s natural to feel a bit sore or tired the next day, but take it easy if you feel pain.
Once your routine is no longer challenging, consider increasing the intensity. A study that looked at the relationship between walking pace, bone density, and osteoporosis found that a slow walking pace was associated with the highest risk of osteoporosis while a brisk pace was linked to a reduced incidence of osteoporosis.
“The body always has to be challenged. Choose something you like, so you can stick to a long-term plan,” says Bhatt.
6. Lift Weights
Resistance training, which includes weight lifting and bodyweight exercises, such as squats, can help with both weight loss and overall fitness. One small study found that people with psoriatic arthritis who did resistance training twice a week for 12 weeks experienced reduced disease activity and improved quality of life. Another study found that resistance exercise was effective in reducing disease activity and improving both general quality of life and muscle strength in patients with psoriatic arthritis.
What’s more, building muscle helps with weight loss. That’s because muscle burns more calories than fat does, even at rest, according to Mayo Clinic. Lifting weights may be even more important when you’re cutting back on calories, because your body sheds some muscle mass along with fat when you lose weight. Incorporate strength-training activities that use all the major muscle groups at least two days a week.
Resistance bands are a low-cost alternative to weights, and resistance bands create less tension at the weakest point of the exercise than weights, making them a good option for beginners.
Be sure to review your exercise plans with your doctors and consider working with a physical therapist if you have any joint pain or limitations.
7. Keep a Food Journal
Dietary guidelines from the National Psoriasis Foundation recommend a reduced-calorie diet for people with psoriatic arthritis and obesity. Talk to your doctor to determine the right goal for you. Tracking your calorie intake can be especially helpful. “Studies show that just keeping a simple food journal reduces caloric intake, because it makes you more aware of what you’re eating and helps you make better choices,” says Prest.
One study that followed 142 people on their weight loss journey for 24 weeks found that those who used an online food journal more often reported more weight loss after six months.
“I have used the journal technique with many clients, and they have had great success in reaching their weight loss goals,” says Prest. Free apps and online tracking tools also give you a helpful estimate of your overall diet, but keep in mind they’re not 100 percent accurate, she adds.
8. Prioritize Sleep
Research suggests that many people who have psoriatic arthritis have trouble sleeping. One study found that 66 percent of participants with psoriatic arthritis experienced sleep disturbances — and that the interrupted sleep was associated with inflammation. This can affect not only your weight loss efforts but also your overall health, including psoriatic arthritis symptoms.
“A good night’s sleep helps with pain sensitization and improves pain tolerance, and therefore, psoriatic arthritis symptoms might be better,” says Bhatt. “When the body rests, it rids itself of toxins, which helps improve inflammation. And good sleep helps with weight loss.” Davis suggests people with psoriatic arthritis aim for at least seven to eight hours of sleep each night.
Go to bed and wake up at the same time each day (even on weekends).
Exercise regularly for better sleep, but not too close to your bedtime.
Avoid coffee (and other sources of caffeine) in the evenings.
Have your last meal at least two to three hours before bedtime.
Keep your bedroom cool, dark, and quiet — use your bed for sleep only, not for watching TV or scrolling through social media.
9. Meet With a Specialist
“If [you’re] struggling, seeing a dietitian is a good idea,” says Davis. A dietitian can help you develop a customized meal plan. “People with psoriatic arthritis may find that they have other food-sensitivity issues that may contribute to problems with weight loss. Working with a registered dietitian-nutritionist is a great way to ensure you’re eating the right amount for weight loss,” says Prest. You can search for a registered dietitian-nutritionist near you at Eatright.org.
If you’re struggling with exercise, meet with a physical therapist or personal trainer. These specialists can develop a fitness routine suited to your needs.
Finally, keep at it, because even small changes can be powerful. “We often overemphasize pharmaceutical therapies and underemphasize lifestyle changes,” says Bhatt, “but lifestyle changes are equally important for all arthritis patients.”
10. Talk to Your Doctor About GLP-1 Drugs
Still, medication might be helpful when it comes to weight loss. Glucagon-like peptide-1 agonists, known as GLP-1 medications, are injectable drugs that help people feel fuller and eat less, resulting in weight loss. If you have PsA and want to lose weight, they may be helpful for you, especially if you also have obesity or type 2 diabetes, which is what the U.S. Food and Drug Administration (FDA) has approved them for (meaning your insurance is more likely to cover them for these conditions).
Research suggests that these drugs may be a particularly promising treatment for psoriasis patients with diabetes or obesity comorbidities, offering both cardioprotective benefits and potential improvement in psoriatic symptoms. And an early study, sponsored by Eli Lilly and Company, the maker of the biologic Taltz (ixekizumab) and the GLP-1 Zepbound (tirzepatide) demonstrated that treatment of obesity or overweight with Zepbound reduced the burden of PsA. In this randomized controlled trial, 31.7 percent of patients – adults with PsA and obesity or overweight with at least one weight-related condition – using Taltz and Zepbound together had a 50 percent improvement in PsA activity and weight reduction of at least 10 percent, compared with 0.8 percent of patients taking Taltz alone.
But despite promising findings, more research is needed to compare GLP-1s with standard rheumatologic therapies, to assess long-term effects in autoimmune conditions, and distinguish between metabolic effects and direct effects on the immune system these drugs have.
The Takeaway
Maintaining a healthy weight is vital for managing psoriatic arthritis, as excess weight can exacerbate symptoms and interfere with treatment efficacy.
Foods high in sugar and unhealthy fats should be minimized, while a diet rich in fruits, vegetables, and omega-3s can help manage inflammation.
Regular low-impact exercises, such as swimming or walking, can improve joint function and contribute to weight loss, easing the burden of arthritis.
If you're considering medication options like GLP-1 agonists for weight management, consult with your healthcare provider, particularly if you have coexisting conditions like obesity or type 2 diabetes, to understand potential benefits and risks.
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Beth Biggee, MD, is owner and practitioner of Lifestyle and Integrative Rheumatology, a holistic direct specialty care practice in North Andover, Massachusetts. She offers whole-person autoimmune care, lifestyle medicine, and holistic integrative consults.
She has over 20 years of experience in rheumatology and holds board certifications in rheumatology and integrative and lifestyle medicine. Dr. Biggee brings a human-centered approach to wellness rather than focusing solely on diseases.
Biggee graduated cum laude with a bachelor's degree from Canisius College, and graduated magna cum laude and as valedictorian from SUNY Health Science Center at Syracuse Medical School. She completed her internship and residency in internal medicine at Yale New Haven Hospital, her fellowship in rheumatology at Tufts–New England Medical Center, and her training in integrative rheumatology at the University of Arizona Andrew Weil Center for Integrative Medicine.
Following her training, she attained board certification in rheumatology and internal medicine through the American Board of Internal Medicine, board certification in integrative medicine through the American Board of Physician Specialties, and accreditation as a certified lifestyle medicine physician through the American College of Lifestyle Medicine. She is certified in Helms auricular acupuncture and is currently completing coursework in the Aloha Ayurveda integrative medicine course for physicians.
In prior roles, Biggee was medical director and integrative rheumatologist at Rheumission, a virtual integrative rheumatology practice, and she also provided healthcare wellness consulting for Synergy Wellness Center in Hudson, Massachusetts. Biggee taught as an assistant clinical professor of medicine at Mary Imogene Bassett Hospital (an affiliate of Columbia University). She was also clinical associate of medicine at Tufts University School of Medicine and taught Introduction to Clinical Medicine for medical students at Tufts. She was preceptor for the Lawrence General Hospital Family Medicine Residency.
Biggee has published work in the Annals of the Rheumatic Diseases, Arthritis & Rheumatology, Current Opinion in Rheumatology, Medicine and Health Rhode Island, and the Field Guide to Internal Medicine.
Colleen de Bellefonds is a freelance journalist and editor who covers science, health, and parenting. Her reporting and writing regularly appears online for Well+Good, The Bump, and What to Expect, as well as in U.S. News & World Report, Women's Health, Self, and many other publications. She lives in Paris with her husband and two kids.
