What Is the Best Diet for Psoriatic Arthritis?

If you have skin psoriasis, there’s a 30% chance you may develop psoriatic arthritis (PsA) too. PsA is an autoimmune condition that causes inflammation in many parts of the body, resulting in psoriasis rashes and joints that are painful, swollen, and stiff. Like psoriasis, PsA can also be difficult to treat. And even the strongest medications may not be enough. So many people look to add lifestyle changes to their medications to feel healthier. 

A nutritious diet can have many life-enhancing benefits, including better heart and metabolic health, increased energy levels, and improved gut health. And it may also help with symptoms of PsA. 

How does what you eat affect psoriatic arthritis?

It’s important to be up front: Researchers don’t know exactly how different diets affect PsA. But there are links between the foods you eat and the levels of inflammation in the body. 

PsA is an autoimmune disease. The immune system is the body's army. It protects against things that don't belong, like infections. In PsA, the immune system gets confused and causes inflammation in your own body on accident. Scientists think this body-wide inflammation may be the reason why psoriasis and PsA are linked to many other inflammatory diseases. 

Medications that treat psoriasis and PsA calm the immune system. They reduce inflammation, improving symptoms and preventing damage to organs and joints. So, if medications can do this, can adding an anti-inflammatory diet to medications also help? 

Let’s explore how different foods may help — or worsen — PsA.

Anti-inflammatory (Mediterranean) diet: One popular diet that may help psoriatic arthritis

There isn’t enough research to support one “best” diet for people with PsA. The Mediterranean diet is the only one that has some evidence to support its use in people with psoriasis and PsA. In other words, this means avoiding Western dietary patterns. 

The Mediterranean diet seems to be a sensible approach for anyone looking to improve their heart and metabolic health — both of which are very important for people with psoriasis and PsA. 

And making food choices that make your diet more anti-inflammatory (more fruits and veggies, less processed food and sugar) is just overall sensible health advice, says rheumatologist Leah Alon, MD, of the Harlem Health Center and Queens Health Center in New York City.

The Mediterranean diet is a popular anti-inflammatory diet. This eating plan is rich in fiber, antioxidants, omega-3 fatty acids, and monounsaturated fatty acids (MUFA). 

The Mediterranean diet favors:

• Fruits, vegetables, and whole grains

• Beans and pulses

• Fish and seafood

• Poultry, cheese, and eggs

• Nuts and seeds

• Olive oil

• Herbs and spices

The Mediterranean diet also limits foods “typical” of a Western or U.S. diet, such as:

• Refined carbohydrates, like white rice and pasta

• Foods high in saturated and trans fatty acids, like butter, red meat, and fried foods

• Sweetened drinks, like soda, sweetened tea, and coffee drinks 

• Foods high in added sugars and/or salt, like most highly processed and prepackaged foods 

This combination of foods is likely responsible for the lower levels of inflammatory chemicals in the blood of people who eat a Mediterranean diet. 

Studies have shown that a Mediterranean diet can improve heart disease, Type 2 diabetes, and some cancers. But what about PsA?

There’s some evidence that shows a Mediterranean diet might help PsA, but larger studies are needed. 

There’s also evidence that shows a Mediterranean diet might help skin psoriasis.

Keto, Paleo, and other diets that won’t help with psoriatic arthritis

There’s simply no evidence to support the use of other popular diets for people with PsA. This includes diets like the keto diet, Paleo diet, autoimmune protocol diet (AIP), and low-FODMAP diets. And because these diets are extremely restrictive, they may worsen your health if you don’t follow them correctly or if you cut out too many food groups.    

Keto diet 

The ketogenic (keto) diet is a popular diet that focuses on limiting carbohydrates and increasing protein and fats. By limiting carbs, you force your body to go into “ketosis” — a type of energy burning. Ketosis is when your body uses its fat stores for energy because it has run out of carbs. It’s what the body does during a fast. 

There’s some evidence that a ketogenic diet may help people with psoriasis. In one study the keto diet improved blood inflammation levels and skin symptoms in people with psoriasis. Although some people in the study also had PsA, the study did not collect data on arthritis symptoms. 

Overall, there isn’t enough research to recommend or reject the ketogenic diet for PsA. But PsA aside, it’s not easy to stick to the keto diet over a long period of time. 

Intermittent fasting 

Like the keto diet, intermittent fasting can tip your metabolism into ketosis. This type of diet may help to lose weight and lower cholesterol. 

Like the keto diet, intermittent fasting may also help lower levels of inflammatory chemicals in the blood and improve symptoms in people with PsA. 

There are different types of intermittent fasting:

• Fasting for 24 hours a few times per week (the 5:2 method)

• Eating for 8 hours of the day, and then fasting for the remaining 16 hours (16:8)

Humans have fasted episodically for millenia. When you do it safely, fasting can have many physical and mental health benefits. 

But fasting can also be risky if you have certain medical conditions, like diabetes. It’s also not for everyone. You can try a modified fast, like not eating anything from 6PM to 10AM. Make sure to still drink plenty of water. See how you feel, and go from there.

Paleo diet 

Paleo (or Paleolithic) diets are similar to keto diets. They’re also known as ancestral or

hunter-gatherer diets. This way of eating attempts to mimic how our Paleolithic ancestors ate. 

Paleo diets focus on minimally processed and whole foods — specifically plants and animal products. They tend to be high in protein and restrict carbs like grains, dairy products, legumes, and root vegetables. Paleo diets are typically not as carb-restrictive as the keto diet. 

Even though paleo diets are said to be “anti-inflammatory,” there’s no good evidence to show that they improve PsA symptoms. That said, a well-balanced paleo diet may help some people improve their weight, heart health, and diabetes.  

Autoimmune protocol diet (AIP) 

The autoimmune protocol diet (AIP) is a more extreme version of the Paleo diet. It’s a multi-phase elimination diet that’s reported to lower inflammation, rebalance the gut microbiome, and improve symptoms of autoimmune diseases. There’s a book you can follow, which walks you through the elimination and step-by-step reintroduction phases of the diet. It also encourages lifestyle changes, like sleep hygiene, physical activity, and stress management.

Like with the Paleo diet, it’s a highly restrictive diet. While there’s some (low-quality) evidence to suggest that it may improve quality of life for some people with autoimmune disease, the drop-out rate is high. This may be because the diet was too restrictive to keep up or because it didn’t help them feel any better. And there isn’t any evidence to show a link between the AIP diet and PsA in particular. 

Some aspects of the plan may improve quality of life through a focus on sleep hygiene, physical activity, stress management, increased fiber intake, and fewer processed foods. But all these are achievable without needing to adhere to a highly restrictive diet.

Low FODMAP diet 

Like the AIP diet, the low-FODMAP diet is a highly restrictive elimination and reintroduction diet. It involves cutting out high-FODMAP foods, or poorly absorbed carbs. High-FODMAP foods are fermentable oligosaccharides (like grains, nuts, and legumes), disaccharides (dairy products), monosaccharides (found in certain fruits and honey), and polyols (sugar alcohols found in certain fruits and vegetables as well as artificial sweeteners). 

There’s good evidence that it helps improve symptoms of irritable bowel syndrome (IBS). But there’s no evidence that it helps improve the symptoms of PsA. 

Because it’s so restrictive, the low-FODMAP diet is not safe to follow on your own without the support of a trained nutritionist or dietitian. It’s also not safe to follow in the long term, as it can cause vitamin and mineral deficiencies. 

Pagano diet 

John O.A. Pagano is a chiropractic physician who created the “Pagano diet.” This diet claims to heal psoriasis from the inside out using nutrition alone. There’s no scientific evidence to support this. His diet and book are based on his own personal journey and some anecdotal evidence.   

Some elements of the diet overlap with more mainstream recommendations: Exclude so-called “inflammatory foods,” prioritize sleep, and take steps to reduce stress. 

But other recommendations involve avoiding “acid-forming” foods and prioritizing “alkaline” foods — a problematic concept. Only wild-caught fish is allowed as protein, along with up to four eggs a week, poultry, and lamb. There are also restrictions on which fruits and veggies are allowed. 

In short, there’s no scientific evidence that the Pagano diet improves symptoms of PsA. 

A word about weight-loss diets

If you have PsA along with excess weight, then losing weight may help. This isn’t a blanket recommendation to lose weight “just because.” There’s a unique relationship between psoriasis and body fat, and it extends to PsA. Here’s how it works:

• Large amounts of fat cells (adipose tissue) can cause chronic, low-grade inflammation in the body. This can increase the risk of developing PsA if you have psoriasis and worsen symptoms of existing PsA. 

• A BMI in the overweight or obese range makes PsA treatments less effective. That’s because medication doses are based on an “ideal” BMI. Whether that’s fair or right is a separate topic. 

• Carrying around excess weight places extra stress on joints that are already inflamed

Research shows that if you have a BMI that’s considered overweight or obese, losing just 5% of your weight may improve how well your treatment for PsA works. And losing excess weight helps with joint pain and other health complications of psoriasis and PsA, like heart disease and diabetes. 

But weight loss isn’t easy. And if you have a chronic disease like PsA, you likely have a lot on your plate already. So be kind to yourself, and work with your rheumatologist or primary care provider to find a sustainable way to look after your PsA and weight over the long term. 

Foods to avoid with psoriatic arthritis

Whether or not you have PsA, there are health benefits to cutting back on “inflammatory” foods, such as those common in the typical Western diet. Here are some foods to limit: 

• White rice, white pasta, flour tortillas, and other refined carbohydrates 

• Butter, red meat, and fried foods 

• Added sugars, such as those in store-bought snacks and baked goods, sodas, sweetened tea, and coffee drinks 

• Trans fats, like partially hydrogenated oil 

• Highly processed and prepackaged foods 

Gluten and dairy products

Some people may wonder about cutting back on dairy and gluten, but there’s not the same level of evidence to support this. 

Many studies have looked at the effect of gluten-free diets on psoriasis, and some included people who had PsA. People with psoriasis and PsA should only avoid gluten if they also have celiac disease or non-celiac gluten sensitivity. There’s no evidence that a gluten-free diet benefits people with psoriasis and PsA who don’t have celiac or non-celiac gluten sensitivity.  

Gluten and dairy foods are not considered inflammatory for everyone. But if you want to try cutting out either of these, then go about it scientifically. 

Start by excluding either gluten or dairy for 1 month, and keep notes on what you’re eating and how you’re feeling. Then keep notes on how you feel as you slowly reintroduce those foods. You don’t have to exclude both gluten and dairy at the same time. But if you do, reintroduce them separately, so that you can learn more about how each food group affects you. 

Foods to eat when you have psoriatic arthritis

In addition to cutting out inflammatory foods, following an eating plan that favors anti-inflammatory foods can have added benefits for your health, especially for people living with a chronic autoimmune condition like PsA. 

Try to prioritize the following foods in your diet:

• Whole foods and minimally processed foods 

• Fruits and vegetables, especially non-starchy vegetables, like broccoli, kale, Brussels sprouts, and cauliflower 

• Fish, especially those high in omega-3 fatty acids, like salmon, trout, mackerel, and sardines (flaxseed and supplements also contain omega-3 fatty acids) 

• Healthy fats, like olive oil

• Water  

• Foods high in vitamin D, like eggs, mushrooms, milk and soy milk, and fortified breads and cereals (people with psoriasis may be more likely to have low levels of vitamin D) 

Why trust our experts?

Written by:

Aunna Pourang, MD

Aunna Pourang, MD, graduated from the University of Florida College of Medicine’s Medical Honors Program and is board-certified in family medicine (Mayo Clinic). She is also fellowship-trained in integrative medicine (Academy of Integrative Health and Medicine).

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Our editorial standards

Meet our experts