The obesity-inflammation axis in psoriatic disease: mechanisms and therapeutic strategies

Obesity constitutes a substantial burden in psoriatic disease that affects approximately half of patients. Importantly, increased adiposity and psoriatic disease are strongly linked, with obesity functioning as both a possible trigger and a disease modifier. Obesity predisposes individuals to develop psoriasis and is likely to drive, at least partially, the progression from psoriasis to psoriatic arthritis. For people with psoriasis or psoriatic arthritis, obesity is associated with lower rates of remission and poorer responses to treatment. Several mechanisms probably underlie this relationship, including systemic and local pro-inflammatory properties of adipose tissue, increased biomechanical stress on joints and entheses, gut dysbiosis and synergistic effects of osteoarthritis. Notably, weight loss can improve both psoriatic disease course and response to therapy; however, current approaches (such as dietary interventions or bariatric surgery) are difficult to implement. Glucagon-like peptide-1-based therapies are an effective strategy for weight loss in psoriatic disease and might even have additive disease-modifying effects to conventional immunomodulators. Although often overlooked, weight loss intervention and obesity management should be included as an integral part of psoriatic disease treatment algorithms.