Cardiovascular Risk in Psoriatic Arthritis: Mechanisms, Risk Assessment, and Long-Term Management Implications

Beyond its typical synovio-entheseal manifestations, psoriatic arthritis (PsA) is a systemic immune-mediated disease that carries a substantial, independent risk of major adverse cardiovascular events (MACE). The complex interaction of chronic systemic inflammation, a high prevalence of traditional risk factors, and PsA treatment drugs results in this increased cardiovascular burden, which is commonly underestimated in cardiology practice. Adipokine balance, insulin signalling, and lipid metabolism are all impacted by cytokine-driven systemic inflammation, which promotes metabolic abnormalities and accelerated atherogenesis. PsA-specific therapy has a complex and significant effect on cardiovascular risk. While there is evidence that strong inflammation suppression with tumour necrosis factor-α (TNF-α) inhibitors may reduce cardiovascular risk, some medications, such as Janus kinase (JAK) inhibitors, should be carefully considered due to potential side effects. In order to outline the epidemiology and pathophysiology of the PsA-cardiovascular risk nexus, this narrative review synthesises recent data. It also offers a critical framework for managing cardiovascular risk in this susceptible group, advocating for a multidisciplinary approach that incorporates strict management of both inflammation and traditional risk factors to lessen the excessive burden of MACE.