{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T13:04:40Z","timestamp":1784120680631,"version":"3.55.0"},"reference-count":55,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004312","name":"Eli Lilly and Company","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/100004312","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,6,23]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Psoriatic arthritis (PsA) is a chronic inflammatory disease characterised by joint involvement, significant impact on quality of life and frequently linked with obesity, metabolic syndrome and cardiovascular comorbidities. Despite advances in PsA management, obesity remains a critical factor influencing disease severity, treatment response and patient outcomes. We examine the interplay between PsA and obesity, the current clinical guidelines, gaps in clinical practice, research on shared inflammatory pathways, treatment implications and the potential of weight-loss interventions to modify disease progression. This comprehensive narrative review uses a non-systematic search of PubMed, Embase and Scopus databases and analyses literature on PsA, obesity, cytokine signalling and therapeutic outcomes, with priority to clinical trials, meta-analyses and large cohort studies. Obesity exacerbates PsA through systemic inflammation, adipokine dysregulation and mechanical joint stress, contributing to worse clinical outcomes, increased comorbidity and poorer response to biologics. Weight management improves disease activity and therapeutic efficacy, although its effects on PsA pathophysiology remain underexplored. Our review highlights that obesity should be recognised as a risk factor and comorbidity in PsA for the integral management of patients. Further research is needed to elucidate the cytokine and molecular changes induced by weight management, generate more clinical data and optimise personalised management strategies. While clinical guidelines recommend a coordinated care approach to optimising the management of PsA in patients with obesity, emerging clinical data support further focus on the role of targeting inflammation, obesity and metabolic dysfunction to improve long-term PsA outcomes and quality of life, mitigate complications and provide better cardiovascular and overall health to patients.<\/jats:p>","DOI":"10.1136\/rmdopen-2025-006577","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:10:14Z","timestamp":1784117414000},"page":"e006577","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Psoriatic arthritis and obesity: a review of clinical burden and considerations for comprehensive care"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct05822830","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06588296","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Norman","family":"Madsen","sequence":"first","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, and Department of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4756-663X","authenticated-orcid":false,"given":"Laura C","family":"Coates","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph F","family":"Merola","sequence":"additional","affiliation":[{"name":"Department of Dermatology, and Department of Medicine, Division of Rheumatic Diseases, UT Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne","family":"Ho","sequence":"additional","affiliation":[{"name":"Keck School of Medicine, University of Southern California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willa","family":"Hsueh","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5668-4497","authenticated-orcid":false,"given":"Uta","family":"Kiltz","sequence":"additional","affiliation":[{"name":"Ruhr University Bochum, Bochum, Germany"},{"name":"Rheumazentrum Ruhrgebiet, Herne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veena K","family":"Ranganath","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine and Department of Computational Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Deodhar","sequence":"additional","affiliation":[{"name":"Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orrin M","family":"Troum","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, University of Southern California Keck School of Medicine and Providence Saint John\u2019s Health Center, Santa Monica, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Diaz","sequence":"additional","affiliation":[{"name":"Eli Lilly and Company, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9650-7777","authenticated-orcid":false,"given":"Andris","family":"Kronbergs","sequence":"additional","affiliation":[{"name":"Eli Lilly and Company, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Bello","sequence":"additional","affiliation":[{"name":"Eli Lilly and Company, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6620-0457","authenticated-orcid":false,"given":"Philip J","family":"Mease","sequence":"additional","affiliation":[{"name":"Providence Swedish Medical Center and University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Ogdie","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2602-1219","authenticated-orcid":false,"given":"Christopher T","family":"Ritchlin","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, and Department of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026071505100757000_12.3.e006577.1","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s00223-017-0380-2","article-title":"Altered bone remodeling in psoriatic disease: new insights and future directions","volume":"102","author":"Paine","year":"2018","journal-title":"Calcif Tissue Int"},{"key":"2026071505100757000_12.3.e006577.2","doi-asserted-by":"crossref","DOI":"10.3390\/ijms24076390","article-title":"The role of adipokines in the pathogenesis of psoriasis","volume":"24","author":"Kie\u0142bowski","year":"2023","journal-title":"Int J Mol Sci"},{"key":"2026071505100757000_12.3.e006577.3","doi-asserted-by":"crossref","unstructured":"Williams JC , Hum RM , Rogers K , et al . Metabolic syndrome and psoriatic arthritis: the role of weight loss as a disease-modifying therapy. Ther Adv Musculoskelet Dis 2024;16. doi:10.1177\/1759720X241271886","DOI":"10.1177\/1759720X241271886"},{"key":"2026071505100757000_12.3.e006577.4","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-023-03085-9","article-title":"More than skin-deep: visceral fat is strongly associated with disease activity, function and metabolic indices in psoriatic disease","volume":"25","author":"Blake","year":"2023","journal-title":"Arthritis Res Ther"},{"key":"2026071505100757000_12.3.e006577.5","doi-asserted-by":"crossref","DOI":"10.1016\/j.obpill.2021.100004","article-title":"Obesity definition, diagnosis, bias, standard operating procedures (SOPs), and telehealth: an Obesity Medicine Association (OMA) clinical practice statement (CPS) 2022","volume":"1","author":"Fitch","year":"2022","journal-title":"Obes Pillars"},{"key":"2026071505100757000_12.3.e006577.6","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes242"},{"key":"2026071505100757000_12.3.e006577.7","doi-asserted-by":"crossref","DOI":"10.3390\/ijms23147499","article-title":"Exploring the links between obesity and psoriasis: a comprehensive review","volume":"23","author":"Barros","year":"2022","journal-title":"Int J Mol Sci"},{"key":"2026071505100757000_12.3.e006577.8","doi-asserted-by":"crossref","first-page":"301","DOI":"10.5114\/reum.2018.79501","article-title":"Sleep disorders in patients with psoriatic arthritis and psoriasis","volume":"56","author":"Krajewska-W\u0142odarczyk","year":"2018","journal-title":"Reumatologia"},{"key":"2026071505100757000_12.3.e006577.9","doi-asserted-by":"publisher","DOI":"10.1007\/s40744-020-00215-6"},{"key":"2026071505100757000_12.3.e006577.10","doi-asserted-by":"crossref","DOI":"10.1016\/j.xjidi.2021.100064","article-title":"Emerging roles of adipose tissue in the pathogenesis of psoriasis and atopic dermatitis in obesity","volume":"2","author":"Guo","year":"2022","journal-title":"JID Innov"},{"key":"2026071505100757000_12.3.e006577.11","doi-asserted-by":"crossref","DOI":"10.3390\/cells10020216","article-title":"Adipokines and autoimmunity in inflammatory arthritis","volume":"10","author":"Neumann","year":"2021","journal-title":"Cells"},{"key":"2026071505100757000_12.3.e006577.12","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1159\/000511023","article-title":"Obesity prevalence in the long-term future in 18 European countries and in the USA","volume":"13","author":"Janssen","year":"2020","journal-title":"Obes Facts"},{"key":"2026071505100757000_12.3.e006577.13","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1002\/art.39973","article-title":"The development of psoriatic arthritis in patients with psoriasis is preceded by a period of nonspecific musculoskeletal symptoms: a prospective cohort study","volume":"69","author":"Eder","year":"2017","journal-title":"Arthritis Rheumatol"},{"key":"2026071505100757000_12.3.e006577.14","article-title":"Leptin receptor (rs1137101) and brain-derived neurotrophic factor (rs925946) gene variants are associated with obesity in the early- but not in the late-onset population of Hungarian psoriatic patients","volume":"11","author":"Szentkereszty-Kov\u00e1cs","year":"2021","journal-title":"Life (Basel)"},{"key":"2026071505100757000_12.3.e006577.15","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1001\/jamadermatol.2018.1412","article-title":"Dietary recommendations for adults with psoriasis or psoriatic arthritis from the Medical Board of the National Psoriasis Foundation: a systematic review","volume":"154","author":"Ford","year":"2018","journal-title":"JAMA Dermatol"},{"key":"2026071505100757000_12.3.e006577.16","doi-asserted-by":"crossref","DOI":"10.1186\/s13102-022-00397-2","article-title":"The effect of exercise on cytokines: implications for musculoskeletal health: a narrative review","volume":"14","author":"Docherty","year":"2022","journal-title":"BMC Sports Sci Med Rehabil"},{"key":"2026071505100757000_12.3.e006577.17","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-019-1810-5","article-title":"Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study","volume":"21","author":"Klingberg","year":"2019","journal-title":"Arthritis Res Ther"},{"key":"2026071505100757000_12.3.e006577.18","doi-asserted-by":"publisher","DOI":"10.1186\/s42358-022-00243-6"},{"key":"2026071505100757000_12.3.e006577.19","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-018-8702-3"},{"key":"2026071505100757000_12.3.e006577.20","doi-asserted-by":"crossref","DOI":"10.1038\/s41392-023-01655-6","article-title":"Signaling pathways and targeted therapies for psoriasis","volume":"8","author":"Guo","year":"2023","journal-title":"Signal Transduct Target Ther"},{"key":"2026071505100757000_12.3.e006577.21","doi-asserted-by":"crossref","DOI":"10.1002\/ski2.160","article-title":"Obesity-induced immunological effects on the skin","volume":"3","author":"Palanivel","year":"2023","journal-title":"Skin Health Dis"},{"key":"2026071505100757000_12.3.e006577.22","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2023-003157","article-title":"Association between obesity and likelihood of remission or low disease activity status in psoriatic arthritis applying index-based and patient-based definitions of remission: a cross-sectional study","volume":"9","author":"Leung","year":"2023","journal-title":"RMD Open"},{"key":"2026071505100757000_12.3.e006577.23","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.160532"},{"key":"2026071505100757000_12.3.e006577.24","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.171034"},{"key":"2026071505100757000_12.3.e006577.25","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-016-1194-8","article-title":"Impact of body weight on the achievement of minimal disease activity in patients with rheumatic diseases: a systematic review and meta-analysis","volume":"18","author":"Lupoli","year":"2016","journal-title":"Arthritis Res Ther"},{"key":"2026071505100757000_12.3.e006577.26","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-202325"},{"key":"2026071505100757000_12.3.e006577.27","doi-asserted-by":"publisher","DOI":"10.1038\/29795"},{"key":"2026071505100757000_12.3.e006577.28","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12020663","article-title":"Adiponectin, leptin and resistin in patients with psoriasis","volume":"12","author":"S\u0142uczanowska-G\u0142abowska","year":"2023","journal-title":"J Clin Med"},{"key":"2026071505100757000_12.3.e006577.29","doi-asserted-by":"crossref","DOI":"10.1186\/ar4406","article-title":"Progranulin antibodies entertain a proinflammatory environment in a subgroup of patients with psoriatic arthritis","volume":"15","author":"Thurner","year":"2013","journal-title":"Arthritis Res Ther"},{"key":"2026071505100757000_12.3.e006577.30","doi-asserted-by":"crossref","DOI":"10.3390\/biomedicines12040775","article-title":"Increased circulating CD14+ monocytes in patients with psoriatic arthritis presenting impaired apoptosis activity","volume":"12","author":"Lin","year":"2024","journal-title":"Biomedicines"},{"key":"2026071505100757000_12.3.e006577.31","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1038\/s41366-018-0151-9","article-title":"Zinc alpha2 glycoprotein protects against obesity-induced hepatic steatosis","volume":"42","author":"Xiao","year":"2018","journal-title":"Int J Obes (Lond)"},{"key":"2026071505100757000_12.3.e006577.32","doi-asserted-by":"crossref","first-page":"143","DOI":"10.2147\/OARRR.S206931","article-title":"Biomarkers of subclinical atherosclerosis in patients with psoriatic arthritis","volume":"11","author":"Peluso","year":"2019","journal-title":"Open Access Rheumatol"},{"key":"2026071505100757000_12.3.e006577.33","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1111\/jdv.13701","article-title":"The triad psoriasis-obesity-adipokine profile","volume":"30","author":"Coimbra","year":"2016","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2026071505100757000_12.3.e006577.34","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-202812"},{"key":"2026071505100757000_12.3.e006577.35","doi-asserted-by":"crossref","DOI":"10.1177\/1759720X21998279","article-title":"Psoriatic arthritis and the association with cardiometabolic disease: a narrative review","volume":"13","author":"Karmacharya","year":"2021","journal-title":"Ther Adv Musculoskelet Dis"},{"key":"2026071505100757000_12.3.e006577.36","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s40744-021-00397-7","article-title":"Psoriatic arthritis: the influence of co-morbidities on drug choice","volume":"9","author":"Patel","year":"2022","journal-title":"Rheumatol Ther"},{"key":"2026071505100757000_12.3.e006577.37","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1136\/annrheumdis-2019-eular.1474","article-title":"FRI0430 Ixekizumab improves the signs and symptoms of psoriatic arthritis regardless of sex, duration of disease, or body mass index in two randomized, phase 3 clinical trials","volume":"78","author":"Eder","year":"2019","journal-title":"Ann Rheum Dis"},{"key":"2026071505100757000_12.3.e006577.38","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2024-225531"},{"key":"2026071505100757000_12.3.e006577.39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jdin.2024.11.009","article-title":"Weight gain secondary to the use of oral Janus kinase inhibitors: a systematic review and meta-analysis","volume":"19","author":"Xiong","year":"2025","journal-title":"JAAD Int"},{"key":"2026071505100757000_12.3.e006577.40","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2109927"},{"key":"2026071505100757000_12.3.e006577.41","doi-asserted-by":"crossref","unstructured":"Grant C , Woodbury M , Skougaard M , et al . Sleep problems in patients with psoriatic arthritis: a systematic literature review and meta-analysis. J Rheumatol 2023. doi:10.3899\/jrheum.2022-1169","DOI":"10.3899\/jrheum.2022-1169"},{"key":"2026071505100757000_12.3.e006577.42","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-020-02294-w","article-title":"Psoriatic arthritis: exploring the occurrence of sleep disturbances, fatigue, and depression and their correlates","volume":"22","author":"Haugeberg","year":"2020","journal-title":"Arthritis Res Ther"},{"key":"2026071505100757000_12.3.e006577.43","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s13555-022-00832-9","article-title":"Economic burden of comorbidities in patients with psoriasis in the USA","volume":"13","author":"Wu","year":"2023","journal-title":"Dermatol Ther (Heidelb)"},{"key":"2026071505100757000_12.3.e006577.44","doi-asserted-by":"publisher","DOI":"10.1038\/s41573-021-00337-8"},{"key":"2026071505100757000_12.3.e006577.45","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keu264"},{"key":"2026071505100757000_12.3.e006577.46","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-022-00798-0"},{"key":"2026071505100757000_12.3.e006577.47","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1177\/2475530318812244","article-title":"American College of Rheumatology\/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis","volume":"4","author":"Singh","year":"2019","journal-title":"J Psoriasis Psoriatic Arthritis"},{"key":"2026071505100757000_12.3.e006577.48","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.ard.2025.02.013","article-title":"Obesity substantially impacts rheumatic and musculoskeletal diseases: time to act","volume":"84","author":"Sattar","year":"2025","journal-title":"Ann Rheum Dis"},{"key":"2026071505100757000_12.3.e006577.49","doi-asserted-by":"publisher","DOI":"10.1097\/rhu.0000000000001949"},{"key":"2026071505100757000_12.3.e006577.50","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2024.102782","article-title":"GLP-1 single, dual, and triple receptor agonists for treating type 2 diabetes and obesity: a narrative review","volume":"75","author":"Alfaris","year":"2024","journal-title":"EClinicalMedicine"},{"key":"2026071505100757000_12.3.e006577.51","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1056\/NEJMoa2416394","article-title":"Tirzepatide as compared with semaglutide for the treatment of obesity","volume":"393","author":"Aronne","year":"2025","journal-title":"N Engl J Med"},{"key":"2026071505100757000_12.3.e006577.52","unstructured":"Nicholls S . The cardiovascular outcomes in participants on tirzepatide versus dulaglutide of the SURPASS-CVOT. In: European Association for the Study of Diabetes. Vienna, Austria: EASD Congress, 2025."},{"key":"2026071505100757000_12.3.e006577.53","doi-asserted-by":"publisher","DOI":"10.1124\/pr.117.014803"},{"key":"2026071505100757000_12.3.e006577.54","doi-asserted-by":"crossref","unstructured":"Merola JF , Mease P , Kivitz A , et al . Ixekizumab with tirzepatide achieved greater disease control than ixekizumab alone in adults with psoriatic arthritis and overweight or obesity: results from a randomized clinical trial. Arthritis Rheumatol 2026. doi:10.1002\/art.70134","DOI":"10.1002\/art.70134"},{"key":"2026071505100757000_12.3.e006577.55","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v2.i2.19"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2025-006577","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:10:39Z","timestamp":1784117439000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2025-006577"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":55,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7,15]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/rmdopen-2025-006577"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2025-006577","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}