Psoriatic arthritis (PsA) is often linked to metabolic syndrome, which involves inflammation and cytokines like interleukin (IL)-17 and IL-23. Studies have shown that dyslipidemia, obesity, and insulin resistance can increase the risk of developing PsA, and weight-loss interventions and medications have been effective in reducing disease activity. This is important because it’s important to address metabolic comorbidities in PsA treatment. Metabolic syndrome can reduce the effectiveness of tumor necrosis factor inhibitors, while PsA treatments may influence metabolic syndrome components. For example, leflunomide may lower weight but raise blood pressure, TNFi drugs can increase weight but improve cardiovascular health. Janus kinase inhibitors can elevate lipid levels and possibly raise cardiovascular risk. Anti-IL-17 and anti-IL-12/IL-23 therapies might pose short-term cardiovascular risks, with long-term effects still uncertain.

While diet and exercise are essential for managing weight, emerging therapies like glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors are promising treatments for PsA patients with metabolic syndrome.

Reference: Williams JC, Hum RM, Rogers K, et al. Metabolic syndrome and psoriatic arthritis: the role of weight loss as a disease-modifying therapy. Ther Adv Musculoskelet Dis. 2024 Aug 19;16:1759720X241271886. doi: 10.1177/1759720X241271886. PMID: 39161788; PMCID: PMC11331474.