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Effect of methotrexate on endothelial function in psoriasis patients
Tiago Almeida Santos Costa1, Isabella Bonilha2, Sheila Tatsumi Kimura Medorima2
1School of Medical Sciences, Dermatology Division, Universidade Estadual de Campinas, Campinas, Brazil.
The Journal of Dermatological Treatment
|May 26, 2026
Summary
Methotrexate (MTX) significantly improved psoriasis severity and lipid profiles in patients. However, it did not impact endothelial function or inflammatory markers, suggesting potential cardiovascular safety in select patients.
Area of Science:
- Dermatology
- Immunology
- Cardiovascular Medicine
Background:
- Psoriasis is a chronic inflammatory disease linked to serious comorbidities like metabolic disorders and cardiovascular mortality.
- Understanding the systemic effects of psoriasis treatments is crucial for managing patient health outcomes.
Purpose of the Study:
- To investigate the effects of methotrexate (MTX) on psoriasis clinical signs.
- To assess MTX's impact on lipid profiles, endothelial function, nitric oxide (NOx) bioavailability, and key inflammatory biomarkers.
Main Methods:
- A 12-week prospective, open-label pilot study involving 29 psoriasis patients treated with MTX (15 mg/week).
- Evaluated clinical outcomes (PASI, BSA, DLQI), lipid profiles, endothelial function (flow-mediated dilation), NOx levels, and inflammatory markers (GSDMD, IL-1β, NLRP3, LOX-1, VCAM-1).
Main Results:
- MTX treatment led to significant improvements in psoriasis severity scores (PASI, BSA, DLQI; p < 0.001).
- A notable reduction in LDL, total cholesterol, and non-HDL cholesterol was observed (p ≤ 0.024).
- No significant changes were detected in endothelial function, NOx levels, or pro-inflammatory biomarkers.
Conclusions:
- Methotrexate effectively improves psoriasis clinical manifestations and lipid profiles.
- MTX did not alter endothelial function or inflammatory biomarkers in this study cohort.
- The findings suggest MTX may be cardiovascularly safe for patients without pre-existing endothelial dysfunction, warranting further investigation.
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