Paucity of Research Found for Nondrug Interventions for PsA

A systematic review of nondrug interventions to improve psoriatic arthritis (PsA) found a dearth of high-quality evidence on their effectiveness. Researchers reported their findings in the journal Clinical Therapeutics.

“In the absence of this evidence, it is not possible to reach any definite conclusion as to whether healthy lifestyle changes and/or nonpharmacologic interventions should be recommended in clinical practice, and it is impossible to estimate their likely impact,” wrote corresponding author Laura C. Coates, MBChB, PhD, of the University of Oxford in the United Kingdom, and study coauthors.

Researchers identified 3 randomized controlled trials and 5 nonrandomized studies published between 2010 and 2021 that met inclusion criteria for the systematic review, which included exposure to nonpharmacologic interventions, psychological interventions, or lifestyle modifications with validated PsA outcomes. Interventions assessed in the studies included physical activity, diet, smoking cessation, and mud bath therapy.

“We hoped to identify studies of nonpharmacologic interventions examining the impact of healthy lifestyle on the management of PsA (eg, topics such as pain, fatigue, mood, alcohol, intimacy, travel, work, social support),” researchers wrote. “Unfortunately, this was not the case.”

Overall, the review revealed significant heterogeneity between studies and wide variation in their disease activity measures and psychological and functional outcomes. Nevertheless, the authors noted that physical activity did appear to have a positive effect on disease activity and psychological well-being in a trio of 12-week studies that investigated it.

“The findings from our systematic review suggest there was limited evidence signifying that exercise, diet, and smoking cessation may improve outcomes, and this should be considered a research priority,” they wrote. “Future studies require a more systematic process of research … to evaluate and answer whether healthy lifestyle programs are beneficial in PsA and, if so, assess which changes should be recommended as therapeutic intervention(s).”

Reference:
Hailey LH, Amarnani R, Bundy C, et al. Lifestyle modifications and nonpharmacologic interventions to improve outcomes in psoriatic arthritis: a systematic review. Clin Ther. 2023;45(9):841-851. doi:10.1016/j.clinthera.2023.05.009