Metabolic comorbidities of PsA


When you have psoriatic arthritis (PsA) you may be more likely to develop certain other health conditions. More than half of people with PsA live with at least one other health condition. This is known as having a ‘co-morbidity’.

The most common co-morbidity for people with PsA is heart disease. But people with PsA are also more likely to develop certain metabolic disorders.


What are metabolic disorders? 

Our metabolism is a set of chemical process that keep our bodies working well. Metabolic disorders occur when there are changes in these processes that result in our bodies having too little or too much of the substances it needs to stay healthy. While there are many different metabolic disorders, there are some that people with PsA are more likely to be living with.



Obesity and overweight are common in people with PsA. This can be due to a number of reasons. For example, sore joints can make it difficult to exercise and a lack of physical activity can make it hard to maintain a healthy weight. Another reason is that arthritis medications, like corticosteroids have been linked to weight gain and obesity. This can make it more difficult for people with PsA to be in a healthy weight range.

Obesity and overweight can increase the risk of different health conditions. They can also increase PsA disease activity. This is because fat cells release substances that can increase inflammation. Because of this, it is important to try and maintain a healthy weight.


Metabolic syndrome 

Metabolic syndrome is a group of conditions that often occur together. These include obesity, high cholesterol, high blood pressure and high blood sugar. These conditions increase your risk of type 2 diabetes, stroke and heart disease.  People with PsA and metabolic syndrome tend to have more severe PsA symptoms.


Type 2 diabetes

Type 2 diabetes (also known as ‘diabetes mellitus’) is when the body does not make enough insulin or use insulin efficiently. Insulin breaks down sugar in food so it can be used for energy.  If this process does not work well, the sugar stays in the blood, leading to high blood sugar levels.

The cause of type 2 diabetes is unknown. Risk factors include family history and lifestyle factors, such as physical inactivity, poor diet and being overweight.

Research shows that people with PsA have a higher risk of developing type 2 diabetes.  The risk is greater in people with higher levels of PsA disease activity. The cause of this increased risk is unknown. It’s thought that both the underlying inflammation of PsA and higher rates of obesity in people with PsA may contribute.


Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease is a chronic health condition where fat builds up in the liver. In some cases, excess fat can cause the liver to become inflamed. This inflammation can damage the liver and increase the risk of side effects from some medicines used to treat PsA. This can lead to serious complications.

More people with PsA have fatty liver disease than the general population. This higher rate may be caused by shared risk factors, such as overweight and obesity, type 2 diabetes and high triglycerides (type of fat found in the blood).


You can reduce your risks 

Just because you have PsA does not mean you will develop metabolic comorbidities. You can reduce your risk of developing these conditions by maintaining a healthy lifestyle. A healthy lifestyle will also decrease your risk of developing other health conditions, improve the effectiveness of your medicines and reduce inflammation.


Stay active

Try to do aerobic and strengthening exercises during the week. Exercise can protect your blood vessels, help you lose weight and reduce the risk of other metabolic conditions. There’s also evidence that exercise can fight inflammation. Exercise can also help manage arthritis pain, improve joint function, and strengthen muscles.

It is important to talk with your doctor before starting new exercises. Your doctor, physiotherapist or exercise physiologist can suggest specific exercises that are appropriate for you. Read Exercise and PsA for more information.


Eat well 

Add extra fruits and vegetables to your diet. Eat fatty fish like salmon and tuna, which are high in anti-inflammatory omega-3 fatty acids. Avoid saturated and trans fats, which contribute to weight gain and fatty and liver disease.  Read Healthy eating for more information


Watch your numbers 

Have your blood sugar, blood pressure and cholesterol levels checked regularly. If they are high your doctor may recommend that you try to lower them with diet and exercise or may prescribe you medications to help if necessary. 


Monitor your liver health 

Some of the medications used to manage PsA, like methotrexate, leflunomide or NSAIDs, can also affect the liver. If you are taking these medications, your doctor will recommend regular tests to monitor how your liver is working.  


Set good habits 

Remember, if you’re trying to change your behaviour, it will take time. Habits, whether good or bad, take time to form so be patient and be kind to yourself. If you have an occasional treat or you experience a setback in setting good habits don’t beat yourself up. This happens to everyone. The important thing is to learn from the experience and just keep trying. Speak to your doctor or a psychologist if you need additional support. 


This resource has been developed based on the best available evidence. A full list of references is available upon request.