Diabetes mellitus and psoriatic arthritis

Psoriatic arthritis (PsA) and psoriasis (PsO) are often associated with metabolic disorders including obesity, metabolic syndrome, diabetes mellitus (DM) and cardiovascular diseases (CVD). It is believed that obesity, DM, PsO and PsA have similar immunopathogenetic mechanisms. Chronic inflammation is closely associated not only with the development of PsO and PsA, but also with the formation of insulin resistance and the development of DM. In patients with DM, as well as with PsO and PsA, acute phase indices and proinflammatory cytokines are increased, including C-reactive protein, tumor necrosis factor α (TNF-α), interleukins 1 and 6 (IL-1 and IL-6), which, regardless of the presence of obesity, are associated with the development of insulin resistance. In PsA and PsO, the use of TNF-α inhibitors increases insulin sensitivity and reduces insulin resistance. It has been shown that the IL-12/23 inhibitor Ustekinumab slows down the development of type 1 diabetes in patients with PsO. Given the high prevalence of diabetes in PsA and PsO, screening should be performed to detect the disease. When choosing therapy for patients with PsA, PsO in combination with type 2 diabetes, the ability of some drugs to improve carbohydrate metabolism should be taken into account, as well as the use of hypoglycemic drugs if necessary.