BETTER metabolic control may meaningfully lower psoriatic arthritis risk for many patients living with psoriasis today. This retrospective cohort analysis from a large US electronic health record network examined whether routinely measured metabolic factors influence progression from psoriasis to psoriatic arthritis.
Metabolic Control And Psoriatic Arthritis Risk
Adults with psoriasis were identified and grouped according to control of key metabolic factors. Poor control required at least three readings showing low high density lipoprotein cholesterol at or below 40 mg per deciliter, triglycerides at or above 150 mg per deciliter, glycated hemoglobin above 7%, low density lipoprotein cholesterol at or above 130 mg per deciliter, or uric acid above 6 mg per deciliter. Investigators then compared psoriatic arthritis incidence between poorly controlled and adequately controlled groups using hazard ratios.
Low high density lipoprotein cholesterol, high triglycerides, and elevated glycated hemoglobin were each linked with higher psoriatic arthritis risk. High density lipoprotein at or below 40 mg per deciliter was associated with a hazard ratio of 1.339 with a 95% confidence interval from 1.022 to 1.755. Triglycerides at or above 150 mg per deciliter carried a hazard ratio of 1.469 with a 95% confidence interval from 1.119 to 1.928. Glycated hemoglobin above 7% was associated with a hazard ratio of 1.144 with a 95% confidence interval from 1.012 to 1.294. In contrast, neither low density lipoprotein cholesterol at or above 130 mg per deciliter nor uric acid above 6 mg per deciliter significantly increased psoriatic arthritis risk.
Clinical Implications for Psoriasis Management
These findings support a closer focus on metabolic control and psoriatic arthritis risk when managing patients with psoriasis in primary care, dermatology, and rheumatology settings. Optimizing high density lipoprotein cholesterol and triglyceride levels, alongside glycemic control, may meaningfully reduce downstream musculoskeletal complications for this high-risk population.
For clinicians, the data reinforce the need to address cardiometabolic risk during routine psoriasis reviews, not only to prevent cardiovascular disease but also to potentially lessen the chance of future psoriatic arthritis. The authors conclude that proactive management of metabolic factors, particularly high-density lipoprotein cholesterol and triglycerides, should be considered part of comprehensive psoriatic disease care.
Reference: Shen YH et al. Influence of Metabolic Factor Control on Psoriatic Arthritis Risk in Psoriasis Patients: A Retrospective Cohort Study Using TriNetX Database. Mayo Clin Proc. 2025;doi:10.1016/j.mayocp.2025.08.024.
