A multinational study found that more than one-third of patients with psoriasis on biologic therapy had persistent systemic inflammation despite significant improvement in skin symptoms.
Investigators analyzed data from 209 adult patients residing in Spain, the United States, and Sweden. All participants were receiving stable biologic treatment and had achieved a Psoriasis Area and Severity Index (PASI) score of 2 or lower, indicating minimal or no active skin disease. However, 36.3% of the patients had high-sensitivity C-reactive protein (hs-CRP) levels ≥ 2 mg/L, a marker of systemic inflammation.
“Psoriasis is associated with a higher cardiovascular disease burden, with systemic inflammation being the root cause of this association,” said lead study author Alba Lecumberri, of Hospital Universitario Ramón y Cajal in Madrid, and colleagues.
Patients with residual inflammation frequently had obesity, fatty liver disease, and elevated visceral fat volume—conditions known to contribute to systemic inflammation. In one cohort, imaging studies confirmed increased inflammatory activity in the liver, spleen, and bone marrow among patients with high hs-CRP, along with greater visceral and subcutaneous adipose tissue.
Obesity was consistently associated with inflammation. Patients with a higher body mass index and waist circumference were more likely to have elevated CRP levels. However, inflammation was also present in some patients who didn't have obesity, suggesting other contributing factors.
Female sex was independently associated with residual inflammation in all three cohorts. Logistic regression showed that female patients had a higher risk of elevated CRP compared with male patients.
The investigators also examined the impact of different biologic therapies. Patients treated with anti–tumor necrosis factor (TNF) agents had a lower likelihood of residual inflammation compared with those receiving interleukin (IL)-17 or IL-12/23 inhibitors. Among patients with elevated baseline hs-CRP, only those receiving anti-TNF therapy reached median CRP levels below 2 mg/L after 1 year.
Low high-dentisty lipoprotein cholesterol levels, a component of metabolic syndrome, were associated with inflammation in some participants.
The findings suggested that skin clearance alone may not reflect full disease control in psoriasis. Persistent systemic inflammation may contribute to ongoing cardiovascular risk in this population.
All participants provided informed consent. The investigators emphasized the importance of monitoring metabolic health in clinical management, particularly in patients with obesity or fatty liver disease.
Further research is needed to assess whether interventions targeting inflammation in adipose tissue or the liver may reduce long-term health risks in patients with psoriasis who otherwise appear clinically controlled.
Full disclosures are available in the study.