Obesity and Smoking Linked to Higher Disease Activity in PsA, According to DEPAR Registry

A large multicenter cohort study from the Dutch South West Psoriatic Arthritis (DEPAR) registry provides new evidence linking modifiable lifestyle factors, particularly obesity and smoking, to disease activity in patients with psoriatic arthritis (PsA).¹ The findings underscore the potential role of lifestyle modification as part of a comprehensive management strategy for PsA patients, especially those with significant physical and psychosocial burden.

High Prevalence of Unhealthy Lifestyle Factors

At baseline, lifestyle-related risk factors were common in the cohort, which was comprised of 938 adults newly diagnosed with PsA between 2013 and 2023. One-third of patients (33%) met criteria for obesity, while more than half (51%) had abdominal obesity. Current smoking was reported in 19% of participants. Alcohol consumption was common (72%), and only a small proportion (3%) was classified as physically inactive.

Compared with the general Dutch population, patients with PsA had higher rates of obesity and heavy alcohol consumption, while smoking rates were similar. Physical inactivity appeared lower in this cohort, although the authors noted potential overreporting due to self-reported data.

To better capture the cumulative impact of lifestyle, investigators developed a composite lifestyle risk score ranging from 0 to 5. This score incorporated 5 factors assessed at baseline: abnormal body mass index (BMI), abdominal obesity, current smoking, no alcohol consumption, and physical inactivity. Higher scores reflected a greater number of risk factors.

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Lifestyle Burden and Worsened Disease Outcomes

The study found a consistent association between higher lifestyle risk scores and increased disease activity at 1 year. In multivariable analyses, each increment in the lifestyle risk score was linked to higher PsA Disease Activity Score (PASDAS) and Disease Activity in Psoriatic Arthritis (DAPSA) scores.

Patients with higher lifestyle risk scores were also less likely to achieve key treatment targets. Specifically, higher scores were associated with reduced odds of achieving low disease activity (LDA) as measured by both PASDAS and DAPSA, as well as lower likelihood of reaching minimal disease activity (MDA).

Obesity and Smoking Drive Associations

When individual lifestyle components were analyzed, obesity and smoking emerged as the primary drivers of worse outcomes. Both general obesity and abdominal obesity were significantly associated with higher disease activity scores and lower likelihood of achieving LDA and MDA.

Similarly, current, moderate to heavy smoking was strongly associated with worse outcomes. Smokers had higher PASDAS and DAPSA scores and were less likely to achieve LDA or MDA compared with non-smokers. In contrast, former smoking and light smoking were not significantly associated with disease activity.

The authors note that both obesity and smoking are linked to systemic inflammation. Obesity contributes to a chronic low-grade inflammatory state through increased production of pro-inflammatory cytokines, while smoking promotes inflammatory pathways and may worsen pain perception.^2,3

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Data on Alcohol and Physical Activity

In contrast to obesity and smoking, alcohol consumption and physical activity were not significantly associated with disease activity in multivariable analyses. Although some associations were observed in unadjusted models, these did not persist after accounting for confounding factors.

The relationship between alcohol and disease activity remains complex, according to the authors. They suggest that observed associations may reflect reverse causality, where patients with higher disease burden modify their drinking behavior. Similarly, the low prevalence of physical inactivity in the cohort limited the ability to detect meaningful associations.

Clinical Implications and Future Directions

This study highlights the importance of addressing modifiable lifestyle factors in PsA care, as baseline assessment of lifestyle behaviors may help identify patients at higher risk of persistent disease activity. While pharmacologic therapy remains central to PsA management, these data support integrating lifestyle interventions like weight management and smoking cessation into routine care. The researchers emphasize that future research should examine how changes in lifestyle over time influence disease outcomes and whether targeted interventions can improve long-term control.

References

1. Hojeij B, Tchetverikov I, Kok MR, et al. Associations of lifestyle-related factors and psoriatic arthritis disease activity: the Dutch south west psoriatic arthritis study. Arthritis Care Res (Hoboken). Published online May 4, 2026. doi:10.1002/acr.80080

2. Nedunchezhiyan U, Varughese I, Sun AR, Wu X, Crawford R, Prasadam I. Obesity, Inflammation, and Immune System in Osteoarthritis. Front Immunol. 2022;13:907750. Published 2022 Jul 4. doi:10.3389/fimmu.2022.907750

3. Rom O, Avezov K, Aizenbud D, Reznick AZ. Cigarette smoking and inflammation revisited. Respir Physiol Neurobiol. 2013;187(1):5-10. doi:10.1016/j.resp.2013.01.013