Influence of Metabolic Factor Control on Psoriatic Arthritis Risk in Psoriasis Patients: A Retrospective Cohort Study Using TriNetX Database.

Abstract

To explore the influence of the control of metabolic factors, including low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TGs), hemoglobin A_1c (HbA_1c), and uric acid (UA), on psoriatic arthritis (PsA) risk in patients with psoriasis (PsO). This retrospective cohort study used data from the TriNetX research network. Data were retrieved from the TriNetX US Collaborative Network in May 2025; the analysis included patient records up to December 31, 2022. Eligible participants were individuals given a diagnosis of PsO. Patients were divided based on the control of metabolic factors. Poor control was defined as having LDL ≥130 mg/dL, HDL ≤40 mg/dL, TG ≥150 mg/dL, HbA_1c >7%, or UA >6 mg/dL at least three instances. The HR was used to compare the rate of PsA occurrence between the poorly controlled and adequately controlled groups. Patients in the HDL ≤40 mg/dL, the TG ≥150 mg/dL, and the HbA_1c >7% group were associated with a significantly increased PsA risk, with an HR of 1.339 (95% CI, 1.022 to 1.755), 1.469 (95% CI, 1.119 to 1.928), and 1.144 (95% CI, 1.012 to 1.294), respectively. However, no significant increase was observed in PsA risk in the patients in the LDL ≥130 mg/dL (HR, 0.983; 95% CI, 0.775 to 1.245), or UA >6 mg/dL (HR, 1.168; 95% CI, 0.863 to 1.581) group compared with their respective lower-level counterparts. Managing metabolic factors including HDL and TG levels may reduce PsA risk in patients with PsO.