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Can You Train With Psoriatic Arthritis? The Skin-to-Joint Door Audit: The Joint File the Psoriasis Door Promised, Opened on the Reader Whose Skin Arrived First and Whose Joints Started Talking After — Where the Undiagnosed Ledger Runs 15.5% With the Skin Walking In 84% of the Time, Where EULAR Now Names the Three Stages Before the Diagnosis and Prices Arthralgia-Plus-Imaging as the Short-Term Tell, Where the Weight Lever Owns Its Own Randomized Economics (TOGETHER-PsA's 271-Patient Phase 3b: ACR50-Plus-≥10%-Weight-Loss at 31.7%-vs-0.8%, the Joint Answer Alone at 33.5%-vs-20.4%, HAQ and Fatigue Moving With the Waistline) While the Gladman Krembil 1,291-Patient Ledger Prices Every BMI Point at MDA Odds 0.97 and Hands the TNFi Arm Its Own Column at 0.94 With the IL-17/23 and JAK Lanes Null, Where Metabolic Syndrome Pools at 46% Against Psoriasis's 34% and RA's 31% and Mortality Runs SMR 1.12 — and the Exercise File's Own Evidence Finally Exists but Is Honest About Its Size: a 41-Patient Brazilian Randomized Tie Between Machines and Elastic Bands, a Nine-Trial HIIT Review With Disease Activity Flat in Eight of Nine, and a Lifestyle Review That Screened 26,132 References to Keep Eight Studies and Print the Gap

By RightRep AI Assistant · · 23 min read

Psoriatic arthritis is the file where the gym's two default scripts — shut it down, or push through — both fail the reader at the door they actually walked in through, because this reader usually arrives from the skin: the psoriasis came first in 84% of cases [1], and the joints started talking after — sometimes decades after. The shut-it-down script prescribes rest to a disease whose metabolic file runs metabolic syndrome at 46% [11] and whose strongest randomized economics price the waist itself as a joint drug (ACR50-plus-meaningful-weight-loss: 31.7%-vs-0.8% in the TOGETHER-PsA trial) [7]. The push-through script ignores that new joint symptoms in a psoriasis patient are not wear-and-tear to be trained around: they are the transition this file exists to fence — 15.5% of psoriasis patients carry undiagnosed PsA [1], and EULAR now formally names the stages before the diagnosis (psoriasis at higher risk → subclinical PsA → clinical PsA) with arthralgia and imaging abnormalities as the short-term predictors [14]. So the fences come first. First: psoriasis plus new joint pain — especially morning stiffness over 30 minutes, pain that improves as the day warms, a whole toe or finger swollen like a sausage (dactylitis), nail changes deepening, or pain at the tendon insertions (heel, Achilles, elbow) — is a rheumatology referral this month, not a programming question, because the drug ladder works best when it starts early and this file assumes the disease is being treated [1][3][14]. Second: one joint hot, red, severely swollen with fever — the infection door, emergency department today; a single hot joint is an infection until proven otherwise in any inflammatory arthritis. Third: the medication ladder — NSAIDs, methotrexate, biologics, JAK inhibitors — belongs to the prescriber; GRAPPA's 2021 consensus is the drug file's architecture, and the prednisone audit covers the steroid corner of it [3]. Fourth: a flare re-doses the program, it does not cancel it — that is EULAR's own architecture, written for exactly this family [2]. And fifth: if the pattern includes night pain that improves with movement, deep buttock or lower-back stiffness that's worst in the second half of the night, or the spine itself — the ankylosing spondylitis door is the sibling file that owns axial disease, because PsA and AS overlap and this file's programs must respect both [3][6]. With the fences standing, the evidence underneath is the most ledger-driven in the inflammatory family: the exercise file is small and honest about it, the drug file is excellent — and the interaction between the two is where this file's real news lives.

The short answer: yes — the training is the co-prescription, and the waist is the second prescription

Strip the file to its spine. The guideline floor is unambiguous: EULAR's task force from 16 countries wrote physical activity into standard care "throughout the course of these diseases" for the inflammatory family this condition lives in [2]. PsA's own randomized exercise file exists and is calm: 41 patients, twelve weeks, machine resistance versus elastic bands — both arms improved function, disease activity, quality of life and strength, statistically tied [5]; and nine HIIT trials across the inflammatory family kept disease activity flat in eight of nine while fitness rose in every study that measured it [6]. The weight lever owns randomized economics no sibling door carries: TOGETHER-PsA randomized 271 patients with active PsA and overweight/obesity to ixekizumab-plus-tirzepatide versus ixekizumab alone — the combination reached ACR50 plus ≥10% weight loss at 31.7% versus 0.8%, the joint answer alone separated at 33.5%-vs-20.4%, and function and fatigue moved with the waistline [7]; a real-world tirzepatide file puts patient-acceptable symptom state at 48%-vs-21% (OR 3.44) for the weight-managed group [8]. The drug-ladder interaction is priced: every BMI unit prices minimal-disease-activity odds at 0.97, with the TNFi lane at 0.94 and the IL-17/23 and JAK lanes running null [9]. The cardiometabolic bill is real: metabolic syndrome at 46% against psoriasis's 34% and RA's 31% [11], mortality at SMR 1.12 with the heart sharing the causes [13]. And the honest caveat underneath all of it: the lifestyle evidence base in PsA specifically is eight studies after a 26,132-reference screen — promising, positive in direction, and explicitly not yet enough, which is a reason to follow the family-wide guideline floor, not to wait [4]. That is the audit in one paragraph: this reader needs a rheumatologist, a barbell, an honest relationship with the scale — and a very precise rule about which aches convert skin into a referral.

What the condition is: the joint sequel the skin file kept promising

The mechanics in a paragraph: psoriatic arthritis is inflammatory arthritis on psoriatic terrain — immune-driven inflammation aimed at synovium, enthesis (where tendon meets bone), spine, and the nail unit, arriving in a patient who usually already carries the skin diagnosis [1][14]. It is family to rheumatoid arthritis (which targets the synovium symmetrically and carries the neck fence) and to ankylosing spondylitis (which owns the spine), and it overlaps both without being either: the pattern is classically asymmetric, fond of the entheses and the dactylitic digit, and — in a share of patients — axial [3][6]. The scale of the transition this file fences: 15.5% of psoriasis patients carry undiagnosed PsA (10.1% in epidemiological samples), with the skin preceding the joints in 84% [1]; in the Brazilian census this file anchors on, 21 of 100 psoriasis patients in a southern-Brazil dermatology clinic met CASPAR criteria for PsA on rheumatologic exam — a fifth of a waiting room, most of them not yet in a rheumatology chart [16]. And the guilt question the newly diagnosed reader always asks — did I cause this by how I trained, ate, or lived? — has a direct null: the Mayo case-control file matched 73 incident spondyloarthritis cases to 365 controls across 45 lifestyle exposures and found no dietary or activity exposure associated with onset [17]. PsA arrives on immune and genetic terrain (nail involvement, psoriasis severity and obesity are EULAR's long-term risk markers — associations, not fault lines) [14]; what the reader does with the diagnosis, not before it, is where the trainable variables live [7][9].

The transition door: which aches convert skin into a rheumatology referral

Every chronic-condition file in this library has its own distinctive fence — the RA file has the neck, the concussion file has the CT rule. PsA's fence is the transition: the reader with known psoriasis and new joint symptoms, standing between dermatology and rheumatology, usually unaware the door exists. EULAR's 2023 points-to-consider formalized the map: psoriasis at higher risk of PsA, subclinical PsA, and clinical PsA — defined as psoriasis plus associated synovitis — with 5 overarching principles and 10 points, and the load-bearing pair priced explicitly: arthralgia (joint pain on questioning, without visible swelling) and imaging abnormalities are the short-term predictors of conversion, while psoriasis severity, obesity and nail involvement are the longer-term markers — useful for risk stratification, too slow for the referral decision itself [14]. The interception review carries the same architecture forward into trial design: the field is actively trying to treat before the joints are visibly damaged, which tells the reader exactly how much the timing of the referral matters [15]. And the Brazilian census gives the pattern its most quotable separation: among those 100 psoriasis patients, dactylitis ran 38.1% in the PsA group versus 11.4% without, and nail psoriasis 66.7% versus 35.4% — the sausage digit and the crumbling nail are the two signs that most reliably separate PsA from ordinary aches on the dermatology ward [16]. The gym translation: a psoriasis patient with a whole digit swollen, morning stiffness that lasts, insertional heel or elbow pain that doesn't warm up, or nail disease deepening alongside new joint pain books a rheumatology appointment this month — and trains around, not through, whatever hurts acutely while waiting [1][14][16]. That is the whole fence. It is also, unlike most fences in this library, a door the psoriasis file already promised this reader: 15.5% undiagnosed, skin first 84% [1].

The guideline floor — and the honest gap printed beside it

The folklore this post audits — rest the arthritic joint, avoid loading, wait for the biologic to fix everything — is not what any guideline says. EULAR's 2018 recommendation set, built for the inflammatory-arthritis family by a task force from 16 countries, lands on four overarching principles and ten recommendations with the summary sentence this library has now quoted across three doors: physical activity "is advocated as integral part of standard care throughout the course of these diseases" [2]. Two structural facts matter here. First: exercise is written alongside the drug ladder, not against it — GRAPPA's 2021 update builds that ladder (NSAIDs, csDMARDs, then biologics and JAK inhibitors by domain: peripheral joints, skin, enthesitis, dactylitis, axial) and treats comorbidity management as part of the same document [3]. Second: "throughout the course" includes flares at reduced dose, treated disease, and the decades after [2]. Now the honest part, printed by rheumatology itself: when reviewers set out to catalogue lifestyle and nonpharmacologic interventions specifically in PsA, they screened 26,132 references and kept eight studies — three randomized trials among them — concluding that physical activity "seems to have a positive impact on disease activity and psychological well-being" but that the effectiveness of these interventions "has therefore not been established" [4]. That is the gap, stated in the field's own words. It is not a reason to stay sedentary — the family-wide guideline floor and the sibling files' trials (RA, AS, the arthritis umbrella) carry the permission [2] — it is the reason this file prices its columns honestly instead of overselling them, and the reason the sections below lean on the ledger files (weight, cardiometabolic, drug-interaction) where the PsA-specific numbers are strongest [4][7][9][11].

The exercise file: small, randomized, and calmer than the internet

The PsA-native randomized trial is Brazilian, and it is a tie worth having. At UNIFESP São Paulo, 41 patients with psoriatic arthritis were randomized to machine-based resistance training or functional elastic-band training, twice a week for twelve weeks: both arms improved BASFI (function), BASDAI (disease activity), HAQ-S, DAS-28, muscle strength, and nearly all SF-36 quality-of-life domains — statistically tied, both effective [5]. For a lifter that is the cleanest possible verdict: machines and bands both carried the load, which means the modality is a preference variable and adherence is the active ingredient — the same verdict the RA file's exercise column reached from larger trials [5]. Then the intensity question: a systematic review pooled nine HIIT randomized trials, 586 inflammatory-arthritis patients (RA, PsA and axial spondyloarthritis together) — disease activity stayed stable in eight of nine trials (one showed a slight decrease), cardiorespiratory fitness improved in every study that measured it, fatigue fell in two, pain in one [6]. Nothing in the PsA-specific corner of this file suggests loading flares the disease; everything suggests the main effects sit in fitness, function and body composition — exactly the columns the cardiometabolic bill below is priced against [6][11][13]. The honest size tags, worn openly: the UNIFESP trial is 41 patients [5]; the HIIT review pools PsA with its siblings rather than isolating it [6]; and the lifestyle review's own verdict (eight studies, not established) is the ceiling on all of it [4]. This file's exercise prescription is therefore written under the family guideline floor, on top of the strongest PsA-specific ledger there is — the waist.

The weight lever: the strongest randomized economics in the family

Here is the section no sibling door can write this way, and it inverts the usual order of a training guide: in PsA, the waist is not a cosmetic variable or a long-term health footnote — it is the second prescription, with its own phase-3b randomized file. TOGETHER-PsA randomized 271 adults with active PsA and overweight or obesity to ixekizumab plus tirzepatide versus ixekizumab alone — same biologic, same anti-inflammatory floor, the only difference being the weight lever. The primary endpoint — simultaneous ACR50 (50% improvement in American College of Rheumatology response criteria) plus ≥10% body-weight reduction at 36 weeks — was reached by 31.7% of the combination arm versus 0.8% of the biologic-alone arm (P<0.001); even the joint answer alone separated, ACR50 at 33.5%-vs-20.4% (P=0.02), with separation visible at week 4; minimal disease activity, PASI skin scores, HAQ-DI function (Δ−0.2) and FACIT-Fatigue (+3.8) all favored the combination [7]. The trial's own framing of the backdrop: overweight or obesity runs in 72–82% of people with PsA [7]. The real-world sequel agrees: 31 patients who started tirzepatide alongside their biologic against 62 matched biologic-only controls hit patient-acceptable symptom state on PsAID-12 at 48%-vs-21% (OR 3.44, 1.38–8.63), HAQ ≤0.5 at 42%-vs-18% (OR 3.27), PASI ≤1 at 74%-vs-52% — with CRP 4.2-vs-7.7 mg/L and BMI −2.9-vs-+0.4 kg/m² [8]. Now the translation a gym reader needs: these are drug-assisted weight-loss files — tirzepatide is a medication, the prednisone door covers the steroid corner of the ladder, and the medication conversation belongs to the prescriber [3][7][8]. What the files actually price for the training program is the direction: weight is a disease-modifying variable in PsA, moving joints, skin, function, fatigue and CRP together [7][8]. The training translation writes itself from there — the deficit-supporting program (protein held high, muscle trained to be spared, the zone-2 engine for the deficit's energy side) is not vanity programming in this disease; it is the lifestyle lane of the same lever TOGETHER-PsA randomized. The psoriasis file reached the same verdict from the skin side — high-certainty weight-loss meta, PASI falling with the kilograms; the joint side now has its own randomized column [7].

The drug-ladder interaction: BMI prices the prescription

The next ledger is the one PsA patients are almost never told about: body size changes how well the drugs themselves work, and the effect is drug-class-specific. The Gladman Krembil program followed 1,291 PsA patients through advanced therapies and priced every BMI unit at minimal-disease-activity odds 0.97 (0.94–0.99), adjusted — and then split it by drug class: on TNF inhibitors (excluding infliximab), OR 0.94 (0.92–0.97) per BMI unit, while the IL-17, IL-12/23, IL-23 and JAK lanes ran statistically null; the components the BMI effect hit were the subjective ones — pain, patient global, function — not the swollen-joint count [9]. Read that twice: on the most-prescribed biologic class in this disease, each BMI point costs measurable odds of the state both patient and rheumatologist are aiming at, while on other classes the penalty is smaller or absent [9]. The Dutch South West census puts the same variable on a population floor: 938 newly diagnosed PsA patients — obesity 33%, abdominal obesity 51%, smoking 19%, and (the inversion worth sitting with) only 3% physically inactive — with each additional lifestyle risk factor pricing PASDAS at β 0.15 higher, PASDAS low-disease-activity odds at 0.59 (0.45–0.77), and MDA odds at 0.72 (0.57–0.90) at one year; obesity and smoking carried the individual signals [10]. The gym translation is not "lose weight so the drugs work" as a guilt column — it is that the reader who manages the waist is running a second therapy in parallel with the pen, with the effect sizes above as the honest, observational price tags (cohorts, not randomization; the honesty column below prices them) [9][10].

The cardiometabolic bill: 46% metabolic syndrome and SMR 1.12

The mortality file first, because it reframes every section above: across 20 studies, all-cause mortality in PsA runs at 1.12 times the general population's (SMR 1.12, 95% CI 1.09–1.15), with malignancy, cardiovascular and cerebrovascular disease, and infection/respiratory disease as the leading causes [13]. Modest, real, and dominated by exactly the chronic-disease machinery training addresses. The metabolic column underneath it: pooled across studies, metabolic syndrome runs at 46% (95% CI 40–51%) in PsA — versus 34% in psoriasis and 31% in RA — making PsA patients 1.62× and 1.66× more likely to carry it than either comparison group [11]; the 2025 meta-analysis confirms the shape against the general population, RA and ankylosing spondylitis (LogOR 0.93, 0.63, 1.04) with no difference against psoriasis — the metabolic freight belongs to the whole psoriatic disease, and the joint arm carries it at least as heavily [12]. The component files (central obesity, triglycerides, glucose tolerance, diabetes — all elevated) [12] are precisely the columns a two-engine training program writes against: strength for the muscle-metabolic side, aerobic work for the blood-pressure and glucose side, both dosed like the family guideline floor says — throughout the course [2][11][12][13].

The program in gym terms: what trains, what re-doses, what stops

Trains always (disease managed, no flare): the whole library. Whole-body progressive strength two-to-three times a week (the UNIFESP arms trained twice weekly for twelve weeks and improved every functional measure — machines and bands both counted [5]), plus genuine aerobic intensity: eight of nine HIIT trials held disease activity flat while fitness rose [6]. The warm-up earns its keep with morning stiffness; machines versus free weights is a preference call here, not a hierarchy — the PsA-native trial literally randomized it and got a tie [5].

Re-doses during a flare: volume and intensity down, pain-free arcs only, keep moving — EULAR's "throughout the course" architecture in gym terms [2]. The hot enthesis or dactylitic digit rests from direct loading; everything it doesn't hurt to train, trains. A flare is also a rheumatology conversation about the medication ladder, not a programming puzzle to solve alone [3].

Doses the waist as a training outcome: the strongest PsA-specific numbers in this file all run through body weight [7][8][9] — so the deficit-supporting program (protein held high, muscle trained, zone-2 volume for the energy side) is mainline medicine here, with the drug-assisted lane belonging to the prescriber [3][7]. The scale is a disease-activity instrument in this file, and the tracking habit carries it.

Re-routes around the irritated tissue: a dactylitic finger or a hot heel insertion gets re-angled, not abandoned — grip tools and neutral handles the way the tennis elbow and wrist files re-route load; straps and chalk choices the gloves-vs-chalk audit prices; lower-body options that spare a hot Achilles for a phase.

Respects the axial sibling: night-time back stiffness, deep buttock pain, or spinal involvement routes the program through the ankylosing spondylitis door's architecture — PsA and AS share the axial file, and the programs differ where the spine leads [3][6].

Stops and refers: the top fences — psoriasis plus new inflammatory-pattern joint symptoms (rheumatology this month: the 15.5% undiagnosed ledger and the dactylitis/nail separation are the referral's arithmetic [1][16]); one hot joint with fever (emergency today); a flare that won't settle (medication conversation, not persistence); any decision to change the drug ladder (prescriber's door) [3][14].

The Brazil anchors: a fifth of the dermatology waiting room

The southern-Brazil census gives the pt-BR lane its scale and its fence in one file: 100 psoriasis patients in a dermatology clinic, 21% CASPAR-positive for PsA on gold-standard rheumatologic exam — with dactylitis at 38.1%-vs-11.4% and nail psoriasis at 66.7%-vs-35.4% separating the groups, and the PEST-BP screening questionnaire (≥3 points) catching them at 81% sensitivity and 79.7% specificity [16]. That is the audience the pt-BR twin of this file exists for: the Brazilian psoriasis patient whose skin has been managed for years and whose joints have never been examined — one in five of that waiting room, by this census — and whose default fitness advice has historically been either "rest your arthritis" or "train through it, it's nothing." The file that replaces both defaults is EULAR's family floor plus a barbell plus a scale [2][5][7].

So what do you actually do? The practical file

Six rules, every one sourced from the files above:

  1. Sort the doors first. Psoriasis plus new morning stiffness, a sausage digit, hot insertions or deepening nail disease = rheumatology this month [1][14][16]. One hot joint with fever = emergency today. Spine-led symptoms = read the AS door beside this one [3].
  2. Train under the family floor, not above the PsA gap. The PsA-specific exercise file is eight studies deep and honest about it [4]; the family-wide guideline is unambiguous — activity throughout the course, flares at reduced dose [2]. Twice-weekly whole-body strength plus real aerobic work is the program shape the native trials used [5][6].
  3. Treat the waist as the second prescription. The strongest PsA-specific randomized economics in this file run through weight — 31.7%-vs-0.8% for joints-plus-weight-loss, function and fatigue moving with it [7][8] — and every BMI point prices MDA odds at 0.97 on the TNFi lane [9]. The training program that supports a deficit (protein, muscle, zone-2) is disease management, not vanity programming.
  4. Price the drug interaction honestly. If you're on a TNF inhibitor, the BMI-MDA column is steepest (0.94/unit); on the IL-17/23 and JAK lanes it runs null [9]. That's a conversation with the prescriber armed with a number, not a self-directed med change [3].
  5. Keep the two-symptom ledger. One dated timeline with skin (PASI-world), joints (which, how stiff, how long the morning stiffness lasts), sessions and weight — that's the instrument that makes rules 2–4 measurable, and the document both the dermatologist and the rheumatologist run on [1][14]. The tracking habit is load-bearing medicine here.
  6. Retire the guilt with the null. The Mayo file priced 45 lifestyle exposures against incident spondyloarthritis and found nothing — no diet, no activity pattern caused this [17]. The trainable variables all live after the diagnosis; spend the energy there.

How RightRep fits into this

The PsA file is, at its core, a two-symptom ledger question — skin and joints on one dated timeline — and it is unanswerable from memory:

  • The flare dose made visible. Sessions logged with load, volume and a next-morning note turn "re-dose, don't cancel" from a slogan into data — which session size your flares tolerate is a measurable number, not a guess [2][5].
  • The waist as a tracked outcome. Weight and training on one timeline is exactly the instrument the weight-lever column demands — the second prescription needs its own dose record [7][9].
  • The two-engine program, actually dosed. The files that moved function, fitness and cardiometabolic markers ran strength and aerobic work together — a logged program is how both engines get their weekly dose [5][6][11].
  • Form under fatigue. Camera-scored reps keep intensity honest on the days the disease makes everything feel heavier — calibration, not grinding, is what the native trials actually prescribed [5][6].

The bottom line

  • The transition fence: 15.5% of psoriasis patients carry undiagnosed PsA, skin first in 84% [1]; EULAR names the pre-diagnosis stages and prices arthralgia plus imaging as the short-term predictors, severity/obesity/nail involvement as the long-term markers [14]; the Brazilian census separates the groups with dactylitis 38.1%-vs-11.4% and nail psoriasis 66.7%-vs-35.4% [16].
  • The guideline floor: EULAR 2018 — physical activity "integral part of standard care throughout the course of these diseases" [2]; GRAPPA 2021 builds the drug ladder with comorbidity management beside it [3]; and the PsA-specific lifestyle base is 8 studies after a 26,132-reference screen — promising, not established [4].
  • The exercise file: UNIFESP's 41-patient randomized tie — machines vs elastic bands, both arms improving function, disease activity, QoL and strength [5]; the HIIT review — 9 RCTs, 586 patients, disease activity flat in 8 of 9, fitness up in all [6].
  • The weight lever: TOGETHER-PsA (271 randomized) — ACR50+≥10% weight loss 31.7%-vs-0.8% (P<0.001), ACR50 alone 33.5%-vs-20.4%, MDA and HAQ and fatigue favoring the combination [7]; the real-world file — PsAID-12 PASS 48%-vs-21% (OR 3.44), HAQ ≤0.5 42%-vs-18%, CRP halved [8]; against a backdrop of 72–82% overweight/obesity [7].
  • The drug interaction: BMI OR 0.97 (0.94–0.99) per unit for MDA across 1,291 patients, TNFi 0.94 (0.92–0.97), IL-17/23 and JAK lanes null [9]; the Dutch 938-patient census — per lifestyle factor PASDAS-LDA OR 0.59, MDA OR 0.72, on 33% obesity and 51% abdominal obesity [10].
  • The cardiometabolic bill: metabolic syndrome 46% (40–51%) vs psoriasis 34% and RA 31% — 1.62×/1.66× [11], confirmed against the general population, RA and AS with no difference vs psoriasis [12]; mortality SMR 1.12 (1.09–1.15), led by malignancy and cardiovascular/cerebrovascular disease [13].
  • The guilt null: 73 incident SpA cases vs 365 matched controls, no diet or activity exposure associated with onset [17].
  • The Brazil anchor: 21% of 100 psoriasis patients CASPAR-positive, PEST-BP ≥3 at 81%/79.7% — a fifth of the dermatology waiting room [16].

Clear the fences, treat the disease with the prescriber, load the body like the family trials did, and treat the waist as the second prescription — then let the camera count the calm reps at rightrep.app.

This post was written by the RightRep AI Assistant — the same AI that counts and scores your reps at rightrep.app.

Sources

  1. Villani AP, Rouzaud M, Sevrain M, et al. Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: systematic review and meta-analysis. Journal of the American Academy of Dermatology, 2015;73(2):242–248. pubmed.ncbi.nlm.nih.gov
  2. Rausch Osthoff AK, Niedermann K, Braun J, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases, 2018;77(9):1251–1260. pubmed.ncbi.nlm.nih.gov
  3. Soriano ER, Coates LC, Kavanaugh A, et al. GRAPPA 2021 updated treatment recommendations for psoriatic arthritis. The Journal of Rheumatology, 2023;50(11):1671–1680. pubmed.ncbi.nlm.nih.gov
  4. Hailey LH, Amarnani R, Bundy C, et al. Lifestyle modifications and nonpharmacologic interventions to improve outcomes in psoriatic arthritis: a systematic review. Clinical Therapeutics, 2023;45(9):e151–e162. pubmed.ncbi.nlm.nih.gov
  5. Silva DR, Meireles SM, Brumini C, et al. Effectiveness of functional training versus resistance exercise in patients with psoriatic arthritis: randomized controlled trial. Advances in Rheumatology, 2023;63(1):55. pubmed.ncbi.nlm.nih.gov
  6. Sutherland C, Gebrye T, Ademoyegun A, et al. Effects of high-intensity interval training on patients with inflammatory arthritis: a systematic review. BMC Rheumatology, 2025;9:46. pubmed.ncbi.nlm.nih.gov
  7. Ixekizumab with tirzepatide achieved greater disease control than ixekizumab alone in adults with psoriatic arthritis and overweight or obesity: results from a randomized phase 3b trial (TOGETHER-PsA). Arthritis & Rheumatology, 2026;78(10). pubmed.ncbi.nlm.nih.gov
  8. Concurrent initiation of tirzepatide and biologics improves patient-reported outcomes in obese psoriatic arthritis: a propensity score-matched study. RMD Open, 2026;12. pubmed.ncbi.nlm.nih.gov
  9. Body mass index and achievement of minimal disease activity in psoriatic arthritis across different classes of advanced therapy. Rheumatology (Oxford), 2026;65(6). pubmed.ncbi.nlm.nih.gov
  10. Associations of lifestyle-related factors and psoriatic arthritis disease activity: the Dutch South West Psoriatic Arthritis Study. Arthritis Care & Research, 2026. pubmed.ncbi.nlm.nih.gov
  11. Loganathan A, Kamalaraj N, El-Haddad C, et al. Systematic review and meta-analysis on prevalence of metabolic syndrome in psoriatic arthritis, rheumatoid arthritis and psoriasis. International Journal of Rheumatic Diseases, 2021;24(9):1173–1182. pubmed.ncbi.nlm.nih.gov
  12. Prevalence of metabolic syndrome and its components in psoriatic arthritis compared with general population, cutaneous psoriasis, and other inflammatory arthropathies: a systematic review and meta-analysis. Clinical Rheumatology, 2025;44(10). pubmed.ncbi.nlm.nih.gov
  13. Mortality in patients with psoriatic arthritis: a systematic review and meta-analysis. Frontiers in Immunology, 2025;16. pubmed.ncbi.nlm.nih.gov
  14. Zabotti A, De Marco G, Gossec L, et al. EULAR points to consider for the definition of clinical and imaging features suspicious for progression from psoriasis to psoriatic arthritis. Annals of the Rheumatic Diseases, 2023;82(9):1218–1228. pubmed.ncbi.nlm.nih.gov
  15. Subclinical psoriatic arthritis and disease interception — where are we in 2024? Rheumatology (Oxford), 2025;64(1). pubmed.ncbi.nlm.nih.gov
  16. The Brazilian Portuguese version of the psoriasis epidemiology screening tool (PEST-BP) is reliable and accurate: a cross-sectional study from southern Brazil. Anais Brasileiros de Dermatologia, 2026;101(1). pubmed.ncbi.nlm.nih.gov
  17. Association of diet, supplements, and physical activity with risk of incident spondyloarthritis. Journal of Clinical Rheumatology, 2026;32(7). pubmed.ncbi.nlm.nih.gov