High Body Mass Index (BMI) Psoriasis is Associated With a Higher Prevalence of Cardiometabolic Disease, Psoriatic Arthritis, and Systemic Inflammation

Introduction: Psoriasis and obesity share inflammatory pathways and are thought to have a bidirectional relationship with overlapping comorbid complications that can impact overall patient health. In this analysis, we evaluated baseline data from 17 clinical trials of patients with moderate-to-severe psoriasis to assess baseline comorbidities across the BMI spectrum. Methods: This integrated data set included 17 randomized clinical trials on psoriasis described by Lebwohl et al. (2025). Participants were adults with moderate-to-severe psoriasis. Baseline comorbidities and disease severity were analyzed by the following BMI groups ≥18.5 to <25 (Normal), ≥25 to <30 (Overweight), and ≥30 (Obesity). The non-parametric Mann-Whitney U test was used to statistically compare differences between the Obesity or Overweight groups vs the Normal group, with p-value ≤0.05 signaling statistical differences. Results: Among a total of 7029 trial participants, BMI groups included 1710, 2291, and 3028 participants in the Normal BMI, Overweight and Obesity categories, respectively. Mean BMIs (Kg/m2) were 36.7, 27.5 and 22.5 for Obesity, Overweight and Normal BMI groups respectively. Participants with Obesity and Overweight had statistically significantly higher baseline prevalence of comorbidities: hypertension in Obesity (41.7% [40.0%; 43.5%]) and Overweight (24.5% [22.7%; 26.2%]) groups vs Normal BMI (10.8% [9.3%; 12.3%]) group: hyperlipidemia in Obesity (25.2% [ 23.6%, 26.7%]) and Overweight (16.8% [15.2%; 18.3%]) groups vs Normal (8.3% [7.0%, 9.6%]) BMI group; diabetes in Obesity (16.9%, [15.6%; 18.2%]) and Overweight (8.1%, [7.0%; 9.2%]) groups vs Normal BMI (3.5%, [2.6%; 4.4%]) group; cardiovascular disease in Obesity (3.1% [2.5%; 3.8%]) and Overweight (2.0% [1.4%; 2.5%]) groups vs Normal BMI (0.9%[0.5%; 1.4%]) group; asthma in Obesity (7.3% [6.4%; 8.2%]) and Overweight (4.1% [3.3%; 4.9%]) groups vs Normal BMI (3.6% [2.7%; 4.5%]) group; metabolic dysfunction-associated liver disease in Obesity (3.4%[2.7%; 4.0%]) group vs Normal BMI (0.9% [0.4%; 1.3%]) group.No significant difference was observed between the Overweight and Normal BMI groups for metabolic dysfunction-associated liver disease. Psoriatic Arthritis (PsA) baseline diagnosis was higher in Obesity (23.6% [22.1%;25.2%]) and Overweight (18.2% [16.6%; 19.8%]) groups vs Normal BMI (14.5% [12.8%; 16.2%]) group. CRP levels (C-Reactive Protein (Mean mg/L(SD)) levels were also significantly higher in Obesity (7.6(10.6), p <0.001) and Overweight (4.2(7.0), p <0.001) groups vs Normal BMI (4.1(11.3)) group. Measures of psoriasis severity including Static Physician’s Global Assessment (sPGA) score and Psoriasis Area and Severity Index (PASI) were significantly higher in Obesity vs Normal BMI groups. Conclusion: In patients with moderate-to-severe psoriasis, Overweight or Obesity was associated with higher baseline psoriasis severity, cardiometabolic burden, asthma, metabolic dysfunction-associated liver disease, PsA, and systemic. These burdens underscore the broader unmet healthcare needs in high BMI psoriasis. With new options to manage both moderate-to-severe psoriasis and overweight or obesity BMI, there may be an opportunity for dermatologists to intervene to modify the overall health and disease of patients with both moderate-to-severe psoriasis and obesity or overweight BMI.