Metabolic Syndrome and Its Components in Psoriatic Arthritis

Abstract

Psoriatic arthritis (PsA) is a well-known inflammatory disorder with a wide variety of phenotypes that extend beyond the joints. It has been defined as an immune-mediated disorder in which Th-1 and Th-17 cells play a key role. It has been associated with an elevated risk of metabolic syndrome (MetS), which is characterized by abdominal obesity, hypertension, hyperglycemia, and hyperlipidemia. While the exact pathophysiology of the link between PsA and MetS has yet to be precisely determined, persistence of inflammatory abnormalities, with overexpression of pro-inflammatory cytokines, might be the cause. Studies have consistently emphasized the strong association between elevated risk of developing cardiovascular disease and MetS in individuals with underlying PsA. The literature has also shown an association between the increased PsA severity and the increased frequency of MetS components. This association has important clinical consequences when treating patients with PsA. Therefore, screening programs should be implemented for PsA patients to evaluate whether they have MetS, and appropriate treatment should be given to manage cardiometabolic risk factors. Patients should also be closely monitored for potential adverse treatment effects on co-morbidities. This article summarizes the evidence of associations between several components of MetS and PsA and analyzes the impact of treatment on these factors.

Keywords: cardiovascular disease; metabolic syndrome; psoriatic arthritis; treatment.

Figure 1

The link between inflammation, psoriatic arthritis, and metabolic syndrome; Obesity is one of the important components of metabolic syndrome and is a well-known risk factor for psoriatic arthritis. Both obesity and PsA share a complex relationship that is likely bidirectional. Increased pro-inflammatory cytokines, secretion of adipocytokines from adipose tissue, increased of oxidative and endoplasmic reticulum stress, and dysbiosis of intestinal microbiota all play a role in the development of MetS and increase the risk of cardiovascular disease in psoriatic patients.