Clinical-Metabolic and Inflammatory Correlates of Psoriatic Arthritis in Patients with Severe Psoriasis

Background: Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disease that develops in a substantial proportion of patients with psoriasis, particularly those with severe disease. Increasing evidence suggests that clinical severity, metabolic dysfunction, and systemic inflammation may contribute to the transition from cutaneous psoriasis to articular involvement; however, their relative contributions remain incompletely defined.

Aim: To evaluate the clinical, metabolic, and inflammatory correlates of PsA in patients with severe psoriasis, with particular emphasis on disease duration, adiposity measures, and systemic inflammatory status.

Material and methods: This analytical cross-sectional study included 100 adult patients with severe psoriasis, of whom 60 had clinically confirmed PsA and 40 had no joint involvement. Data were collected on demographic characteristics, disease duration, anthropometric measures (body mass index [BMI] and waist circumference), and inflammatory markers (erythrocyte sedimentation rate [ESR]). Group comparisons were performed using independent t-tests, and multivariate logistic regression analysis was conducted to identify independent predictors of PsA. Results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Patients with PsA had a significantly longer disease duration compared to those without PsA (12.0 vs 6.4 years; p < 0.0001). BMI (28.9 vs 26.6 kg/m²; p = 0.00047) and waist circumference (91.7 vs 85.4 cm; p = 1.20 × 10⁻⁷) were significantly higher in the PsA group. ESR levels were also markedly elevated in patients with PsA (19.6 vs 11.0 mm/hr; p = 8.61 × 10⁻¹⁴). In multivariate analysis, disease duration (OR 5.49, 95% CI 1.30–23.15; p = 0.020), waist circumference (OR 1.37, 95% CI 1.05–1.79; p = 0.022), and ESR (OR 1.60, 95% CI 1.13–2.27; p = 0.008) remained independent predictors of PsA, whereas BMI and age were not statistically significant after adjustment.

Conclusion: Psoriatic arthritis in patients with severe psoriasis is independently associated with prolonged disease duration, central obesity, and increased systemic inflammation. Waist circumference appears to be a more clinically relevant metabolic predictor than BMI, underscoring the role of visceral adiposity in disease pathogenesis. These findings support the implementation of integrated clinical and metabolic assessment strategies to facilitate early identification of patients at increased risk of PsA.