Exercise Affects PsA Risk in Patients With Psoriasis

BOGOTÁ, Colombia — While regular physical exercise is known to reduce the risk for a wide array of chronic diseases, its role in preventing psoriatic arthritis (PsA) has not been well studied. As a result, clinicians may hesitate to recommend vigorous exercise for patients with psoriasis because of concerns about potentially triggering joint inflammation in people with subclinical PsA.

But at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 Annual Meeting and Trainee Symposium, Dylan McGagh, MD, a clinical research fellow in rheumatology at Oxford University, Oxford, England, presented evidence that regular exercise could in fact be preventive in this setting. People with prevalent psoriasis but no arthritis who walked more than 10,452 steps (approximately 4 miles) daily saw a 58% lower risk of developing PsA than those who walked very little, McGagh reported.

Moreover, risk was reduced in a dose-dependent manner, with every 1000 steps walked daily correlating to a 10% decrease.

Other measures of exercise also correlated to reduced risk, according to McGagh. “Any moderate-to-vigorous physical activity was associated with reduced risk of PsA,” he said.

For his research, McGagh and his colleagues identified 2531 people (mean age, 63 years; 52% women; 100% White) with psoriasis from the UK Biobank Accelerometry Cohort, which enrolled more than 100,000 people aged 40-65 years between 2013 and 2015. Participants used wearable accelerometers for a median of 7 days to track their movement patterns. They were then followed for up to 8 years, with health records linked.

“We were interested in people with prevalent psoriasis without PsA,” McGagh said at the conference. “We modeled a range of exposures, including steps, peak walking cadence or walking speed, change in hazards per 1000 increase in steps,” and time spent in sedentary and active states.

Higher volume and intensity of physical activity were also associated with lower risk. “The message here is that basically any small amount of activity is beneficial” — something easily conveyed to patients, he said. “But we need to verify this in more diverse cohorts, and there’s a need to characterize physical activity profile across the [disease] continuum,” he cautioned.

The findings were received with interest at a meeting intensely focused on the potential effects of diet, exercise, and body composition on the development of PsA in people with psoriasis, even outside the context of obesity, a known risk factor for PsA in patients with psoriasis. For example, the conference began with a lively debate on whether there is sufficient evidence to recommend treatment with GLP-1 agonists in certain patients who have or are at risk for PsA.

Gary Macfarlane, MD, PhD, of the University of Aberdeen, Aberdeen, Scotland, an epidemiologist specializing in musculoskeletal disease who also presented at the meeting, said in an interview that he found McGagh’s results encouraging. Lifestyle interventions are “powerful” in improving health outcomes in people, he said. “Let’s get people more active. That will improve their mental health as well,” he added.

McGagh was awarded a pilot grant by GRAPPA to continue his research. In an interview at the conference, he commented that this was the first study to “really put physical activity in the driver’s seat in that story of transition” from psoriasis to PsA. He also cautioned that his study cohort was comprised entirely of White individuals, an important weakness of the study, and that the participants with psoriasis were older than typical patients with psoriasis at risk for PsA.

The findings need to be replicated in more representative cohorts, “and we’re working right now to do this,” McGagh said. In the meantime, he said, clinicians should consider it safe to recommend exercise to patients with psoriasis.

McGagh disclosed having no financial conflicts of interest. Macfarlane has received fees and/or research funding from AbbVie, Pfizer, and others.