Metabolic Syndrome in Psoriatic Arthritis Linked to Degenerative Spinal and Enthesopathic Changes

A large observational study published in Arthritis Care & Research evaluating the relationship between metabolic syndrome (MetS) and radiographic features in psoriatic arthritis (PsA) has found that MetS is associated with degenerative and metabolic changes in the spine and entheses but not with radiographic damage in PsA. These findings provide new insights into how cardiometabolic comorbidities may influence skeletal changes in patients with PsA. 

The study analyzed 1422 patients enrolled in a prospective observational cohort from 1978 to 2024. At baseline, 28.1% (400 patients) had MetS; over a median follow-up of 10.59 years, 58.79% (836 patients) had at least 1recorded diagnosis of MetS. The cohort had a mean age of 44.43 years and included 55.5% male patients. 

Researchers used generalized estimating equations analysis to evaluate the independent associations between MetS and radiographic findings. Adjustments were made for age, sex, PsA disease duration, calendar decade, and targeted disease-modifying antirheumatic drug use. 

The results showed no significant association between MetS and axial PsA manifestations, such as syndesmophytes, sacroiliitis, or peripheral joint radiographic damage. However, MetS was significantly associated with calcaneal spurs, diffuse idiopathic skeletal hyperostosis, and degenerative disc disease. 

"MetS is associated with degenerative and metabolic changes in the spine and entheses, but not with radiographic damage in PsA," the study concluded. 

These findings suggest that MetS contributes to non-inflammatory structural changes rather than inflammatory-driven joint damage in PsA. Clinicians managing patients with PsA and coexisting MetS should consider early screening for spinal and entheseal changes, particularly those linked to mechanical stress and metabolic dysfunction. 

The study underscores the importance of metabolic health in PsA management, highlighting a potential role of systemic metabolic factors in musculoskeletal degeneration beyond inflammatory pathways.

Reference
Kharouf F, Gao S, Tunc SE, et al. The association between metabolic syndrome and radiographic changes in psoriatic arthritis: a cohort study. Arthritis Care Res (Hoboken). Published online March 2, 2025. doi:10.1002/acr.25513