Association Between Metabolic Syndrome and Radiographic Changes in Psoriatic Arthritis: A Cohort Study.

Objective: Metabolic syndrome (MetS) is a known comorbidity of psoriatic arthritis (PsA) and is associated with PsA disease activity. We aimed to explore the association between MetS and radiographic features (peripheral and axial) in PsA.

Methods: We included patients with PsA followed at our prospective observational cohort for the period between 1978 and 2024. We identified patients with MetS on longitudinal follow-up and used generalized estimating equations (GEE) analysis to define the radiographic features independently associated with MetS, adjusting for age, sex, PsA disease duration, calendar decade, and use of targeted disease-modifying antirheumatic drugs.

Results: The study population consisted of 1,422 patients, out of which 400 (28.1%) had MetS at baseline (clinic entry) and 836 (58.79%) had a record of MetS (per the harmonized definition) over a median follow-up duration of 10.59 (interquartile range 4.52-18.28) years. The mean (SD) age of our cohort at baseline was 44.43 (12.98) years, with 789 patients (55.5%) identifying as men. Mean (SD) body mass index was 28.79 (6.36) kg/m². In the GEE analysis, MetS was not significantly associated with axial disease or radiographic damage to peripheral joints, assessed as the presence of syndesmophytes or sacroiliitis and the radiographic damaged joint count, respectively. On the other hand, MetS was significantly associated with calcaneal spurs, diffuse idiopathic skeletal hyperostosis, and degenerative disc disease.

Conclusion: MetS is associated with degenerative and metabolic changes in the spine and entheses but not with radiographic damage in PsA.