A RECENT international study has shed light on the complex relationship between psoriasis, systemic inflammation, and cardiovascular disease (CVD), revealing that even patients who achieve clear skin through biologic therapy may continue to experience “residual inflammatory risk” (RI).
Psoriasis, a chronic inflammatory skin condition, is increasingly recognised as a clinical model for studying inflammatory atherogenesis, the process that underpins atherosclerosis, a major cause of death in Western societies. Notably, patients with psoriasis have a reduced life expectancy, often due to cardiovascular events such as myocardial infarction. This elevated risk, not fully captured by traditional assessments, is believed to stem from chronic systemic inflammation.
In this study, researchers examined three international cohorts of patients with moderate-to-severe psoriasis undergoing biologic therapy. Despite achieving low PASI scores, indicating successful skin disease control, a significant number continued to exhibit elevated levels of high-sensitivity C-reactive protein (hs-CRP), a key marker of systemic inflammation and cardiovascular risk. These individuals, predominantly women with central obesity, also showed greater visceral fat, liver steatosis markers, and bone marrow inflammation.
Interestingly, anti-TNF therapies were more effective in reducing hs-CRP compared to IL-12/23 and IL-17 inhibitors. This may reflect broader systemic anti-inflammatory effects of TNF blockers, or differences in patient profiles based on treatment histories. Additionally, low HDL cholesterol, often observed in patients with metabolic syndrome, was associated with RI, possibly due to a loss of HDL’s anti-inflammatory properties.
The findings suggest that systemic inflammation may persist despite clinical resolution of skin symptoms, highlighting a gap in current treatment approaches. As a result, dermatologists and cardiologists may need to consider RI in psoriasis as a distinct therapeutic target, particularly in overweight or obese patients.
While limitations such as short follow-up and lack of control groups exist, this study offers valuable insights into the persistent cardiovascular risk in patients with psoriasis. Addressing RI could lead to more holistic management strategies aimed at reducing both visible and hidden inflammation, ultimately improving long-term health outcomes.
Reference
Lecumberri A et al. Residual inflammation in patients with psoriasis treated with biologic therapy: findings from 3 prospective observational cohorts. J Invest Dermatol. 2025;DOI:10.1016/j.jid.2025.03.014.
