Background/Purpose: Comprehensive assessment of multiple lifestyle behaviours and disease activity outcomes in psoriatic arthritis (PsA) is scarce. We aim to investigate lifestyle behaviours in patients with PsA and their association with disease activity measurements.

Methods: This multicenter cohort included 938 patients newly diagnosed with PsA from the DEPAR study, between 2013 and 2023. Lifestyle behaviours were assessed at baseline and included: body mass index (BMI), waist circumference, smoking, alcohol consumption and physical activity. A comprehensive lifestyle risk score was calculated (range 0 to 5) using these five lifestyle behaviours (BMI outside normal range, abdominal obesity, current smoking, no alcohol consumption, physical inactivity), with higher scores indicating more risk behaviours. No specific treatment protocols were applied. Disease activity was assessed every three months over the course of one year and included: Psoriatic Arthritis Disease Activity Score (PASDAS), disease activity in psoriatic arthritis (DAPSA), PASDAS and DAPSA low disease activity (LDA) and remission, and minimal disease activity (MDA). The associations between the lifestyle risk score and disease activity were analyzed using mixed models adjusted for baseline disease activity, study visit, age, sex, geographic origin, education and medication. Multiple imputations to handle missing data for all covariates were performed in R (version 4.4.2) using mice predictive mean matching and classification and regression trees (pmm and CART; M=20).

Results: The rate of overweight/obesity was 72%, abdominal obesity was 39% in men and 64% in women, current smoking was 22% (of them 41% classified as moderate-to-heavy smoking ( >10 cigarettes per day)), and alcohol consumption was 82% (of them 22% classified as heavy consumption) with 3% of patients physically inactive. Using multivariable analyses, a higher lifestyle risk score was associated with higher PASDAS (βadj 0.15; 95%CI 0.08, 0.23), and lower odds for achieving PASDAS-LDA (ORadj 0.59; 95%CI 0.45, 0.77), and MDA (OR adj 0.72; 95%CI 0.57, 0.90) at one year of follow-up. Similar associations were observed for DAPSA and DAPSA-LDA. Analysis of individual lifestyle behaviours showed that obesity, abdominal obesity and moderate-to-heavy current smoking, were also significantly associated with higher PASDAS and DAPSA, and lower odds for achieving PASDAS-LDA and MDA.

Conclusion: Lifestyle behaviours seem to influence one year disease activity in PsA. Adiposity and smoking were associated with higher disease activity. Patients newly diagnosed with PsA also showed unhealthy lifestyle behaviours.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lifestyle-behaviours-and-disease-activity-in-patients-with-psoriatic-arthritis-the-dutch-south-west-psoriatic-arthritis-study/