Metabolic challenges of glucose and lipid dysregulation in psoriatic arthritis: a narrative review from pathogenesis to clinical practice.

Emerging evidence highlights a complex interconnection between metabolic dysfunction and chronic inflammation in psoriatic arthritis (PsA), positioning glucose and lipid abnormalities not only as comorbidities but as active contributors to disease pathogenesis. In fact, rather than being incidental findings, conditions such as insulin resistance, atherogenic dyslipidemia, and visceral obesity interact with the immune system, amplifying inflammatory circuits and promoting joint and systemic damage. This review delves into the metabolic dimension of PsA, shedding light on how pro-inflammatory cytokines and adipokine imbalances reshape glucose and lipid homeostasis. Special attention is given to molecular pathways, such as impaired insulin signaling and altered lipid uptake, that link systemic inflammation to cardiometabolic risk. Furthermore, we examine the impact of these metabolic alterations in clinical practice and how antirheumatic therapies might improve metabolic balance and promote long-term cardiovascular protective effects. By unraveling these interactions, we aim to provide new insights into the clinical management of PsA and underscore the need for integrated therapeutic strategies that address both inflammation and metabolic health.