Psoriatic Arthritis and Metabolic Syndrome: Is There a Role for Disease Modifying Anti-Rheumatic Drugs?

Abstract

Although psoriatic arthritis (PsA) primarily leads to joint and skin damage, it is associated with higher prevalence of metabolic syndrome (MetS) and its components, namely hypertension, dyslipidemia, obesity, and type II diabetes. Additionally, chronic inflammation is known to aggravate these cardiometabolic factors, thus explaining the enhanced cardiovascular (CV) morbidity and mortality in RA. Furthermore, emerging evidence suggest that some risk factors can fuel inflammation, thus pointing to a bidirectional crosstalk between inflammation and cardiometabolic factors. Therefore, dampening inflammation by disease-modifying anti-rheumatic drugs (DMARDs) may be thought to ameliorate MetS burden and thus, CV risk and disease severity. In fact, recommendations for PsA management emphasize the need of considering comorbidities to guide the treatment decision process. However, the existing evidence on the impact of approved DMARDs in PsA on MetS and MetS components is far from being optimal, thus representing a major challenge for the clinical setting. Although a beneficial effect of some DMARDs such as methotrexate, TNF inhibitors and some small molecules is clear, no head-to-head studies are published and no evidence is available for other therapeutic approaches such as IL-23 or IL-17 inhibitors. This narrative review summarizes the main evidence related to the effect of DMARDs on MetS outcomes in PsA patients and identify the main limitations, research needs and future perspectives in this scenario.

Frequency of Renal Function Parameter Abnormalities in Patients with Psoriatic Arthritis and Rheumatoid Arthritis: Real-World Evidence from Clinical Practice

“…A sex-adjusted linear regression model confirmed that patients with PsA were significantly taller (p = 0.015), weighed more (p = 0.001), and thus had higher BMI (p = 0.01) than patients with RA. The finding of higher weight, BMI, and prevalence of hypertension in PsA patients compared with RA patients is consistent with the high incidence of CV risk factors among patients with PsA reported in literature [21]. Participants in the two disease groups were comparable regarding past medical history, but significantly more patients in the RA group were smokers, whereas significantly more patients in the PsA group had comorbid hypertension (Table 1).…”

Small Intestinal Permeability and Metabolomic Profiles in Feces and Plasma Associate With Clinical Response in Patients With Active Psoriatic Arthritis Participating in a Fecal Microbiota Transplantation Trial: Exploratory Findings From the FLORA Trial

“…Both treatment with MTX and TNFi have previously been linked to improved insulin sensitivity ( 45 , 46 ). Moreover, because no patients were treated with systemic corticosteroids during the trial, we do not think that DMARDs are the likely cause of the elevated plasma glucose levels observed in the failure group.…”

Metabolic Syndrome and Its Components Have a Different Presentation and Impact as Cardiovascular Risk Factors in Psoriatic and Rheumatoid Arthritis

“…With regards to CV risk factors associated with PsA, the available evidence shows that metabolic comorbidities, obesity in particular, are involved [14,15,35]. The distinction in terms of CV risk profile from RA, despite the fact that both diseases are characterized by chronic inflammation, has been previously addressed [8,9,35,36]. It has been pointed out that, contrary to RA where systemic inflammation appears to contribute directly to the increased CV risk, in PsA traditional risk factors, including adiposity and MetS, are major contributors to the CV risk [8,35,37].…”

“…An elevated risk of CV and cerebrovascular events compared to the general population has also been reported for psoriatic arthritis (PsA) [2,7]. The increased CV risk associated with RA and other chronic inflammatory conditions is likely caused by the complex interplay of traditional CV risk factors, chronic systemic inflammation, and side effects related to the use of certain antirheumatic medications [8,9]. Although a similar figure has been proposed for PsA, to what extent these arthropathies differ is yet to be clarified.…”