Vol.:(0123456789) 1 3 Rheumatology International https://doi.org/10.1007/s00296-019-04458-7 OBSERVATIONAL RESEARCH Mediterranean diet and Psoriatic Arthritis activity: a multicenter cross‑sectional study Francesco Caso 1  · Luca Navarini 2  · Francesco Carubbi 3  · Andrea Picchianti‑Diamanti 4  · Maria Sole Chimenti 5  · Marco Tasso 1  · Damiano Currado 2  · Piero Ruscitti 3  · Massimo Ciccozzi 6  · Antonio Annarumma 1  · Bruno Laganà 4  · Roberto Perricone 5  · Antonella Afeltra 2  · Roberto Giacomelli 3  · Rafaele Scarpa 1  · Luisa Costa 1 Received: 29 July 2019 / Accepted: 27 September 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Diet is a modifable factor implicated in chronic systemic infammation, and the mediterranean dietary pattern is considered to be a healthy model in terms of morbidity and mortality. The main aim of this study was to evaluate the adherence to the mediterranean diet in patients with Psoriatic Arthritis (PsA) and its impact on disease activity. A cross-sectional observational study was conducted in a cohort of 211 consecutive PsA patients. We evaluated PsA activity by disease activity index for PSoriatic Arthritis (DAPSA) and composite psoriatic disease activity index (CPDAI). The NCEP-ACT III criteria were used to identify subjects with MetS, and in each subject, we evaluated body mass index (BMI). A validated 14-item questionnaire for the assessment of adherence to the mediterranean diet (PREDIMED) was recorded for all the enrolled subjects. Patients showed a median age of 55 (48–62) and disease duration was 76 (36–120) months. 27.01% of patients were classifed as having MetS. The median of the mediterranean diet score (MDS) was 7 (6–9). A moderate adherence to mediterranean diet was found in 66.35% of the entire cohort; 15.64% and 18.01% of the patients showed low- and high adherence to the dietary pattern, respectively. We found a negative association between DAPSA and adherence to mediterranean diet (B = − 3.291; 95% CI − 5.884 to − 0.698). DAPSA was positively associated with BMI (B = 0.332; 95% CI 0.047–0.618) and HAQ ( B = 2.176; 95% CI 0.984–3.368). Results from our study evidenced that in PsA patients, higher levels of disease activity as measured by DAPSA correlated with low adherence to mediterranean diet, suggesting potential beneft of antinfammatory properties of this dietary pattern. Keywords Body mass index · C-reactive protein · DAPSA · Mediterranean diet · Psoriatic Arthritis Introduction Psoriatic arthritis (PsA) is an infammatory arthropathy associated with psoriasis and heterogenous manifestations [1, 2]. Among those, atherosclerosis, obesity, and metabolic syndrome (MetS) have been described as possible pheno- typic aspects of the underlining infammatory process [3–5]. However, high severity of PsA and increased prevalence of cardiovascular (CV) disease and its risk factors have also been explained by unhealthy lifestyle and nutritional aspects [6]. Diet is a modifable factor implicated in chronic systemic infammation, as well in psoriatic disease. Nevertheless, the relationship between dietary pattern and PsA incidence and severity has been scarcely studied [7, 8]. Particularly, it has been demonstrated that PsA patients have an excessive con- sumption of calories, lipids, fatty acids, and cholesterol [9]. Furthermore, very low energy diet along with short-term weight loss treatment has been found to be associated with signifcant positive efects on articular and entheseal severity in PsA patients with obesity [10]. Intermittent fasting (Ramadan fasting) has been reported to be associated with benefcial efects on PsA disease activity, expressed by disease activity index for Psoriatic Arthritis (DAPSA) and bath ankylosing spondy- litis disease activity index (BASDAI), enthesitis, and dac- tylitis, independently by weight loss [11]. This has been Rheumatology INTERNATIONAL * Francesco Caso francescocaso1@yahoo.it; francesco.caso@unina.it Extended author information available on the last page of the article