The Metabolic Profile of Psoriatic Disease

Psoriatic disease is an autoinflammatory, autoimmune systemic disease characterized by the presence of psoriasis which may be accompanied by psoriatic arthritis (PsA). The disease is characterized by the presence of metabolic syndrome. Obesity, arterial hypertension, diabetes mellitus type 2, hyperlipidemia and fatty liver disease may be observed in patients with psoriatic disease. The pathophysiology of metabolic syndrome in patients with psoriatic disease has not been completely elucidated. However, hyperinsulinemia may be observed and may be implicated in the pathogenesis of systemic inflammation observed in psoriatic disease. All components of the metabolic syndrome in patients with psoriatic disease need treatment. Arterial hypertension should be managed, diabetes mellitus should be managed, and hyperlipidemia should be specifically therapeutically tar-geted. The presence of obesity may necessitate specific adaptation of the management of PsA such as ad-justment of the dose of biologic agents applied for the management of the disease. Weight loss induced either by diet or surgically or via an incretin-based approach improves psoriasis. Weight loss may prevent progression of psoriasis to PsA. Weight loss may improve disease activity in PsA. Modern treatment modalities in the man-agement of obesity hold a great promise in the treatment of psoriatic disease as they appear to have both metabolic as well as immune modulating effects. In this review the pathophysiology, management and thera-peutic implications of metabolic syndrome in patients with psoriatic disease will be discussed.