Table 1

Pragmatic guidance on tests to screen for cardiovascular and metabolic risks in patients with psoriasis and PsA lending on recent advances from work in the general population, and suggestions for future research

Tests, questionsCurrent recommended managementFuture research
CVDLipids, blood pressure, smoking historyScreen according to usual CVD risk scores. Treat if CVD risk or blood pressure beyond recommended treatment thresholds in accordance with national guidelines. Advice/interventions to stop smokingFurther epidemiological studies addressing CVD risk in psoriasis and PsA. Effects of psoriasis treatments on CVD risk using proven surrogate measures (accepting long-term RCTs may be unethical)
ObesityBMILifestyle intervention if BMI >25 kg/m2: dietary change, physical activity (if appropriate)More on the lifestyle patterns of patients with different severities of psoriasis and PsA. More lifestyle intervention studies addressing behavioural, activity and dietary aspects
DiabetesHBA1c (in those with BMI ≥25 kg/m2)HBA1c (41 mmol/mol)=lower risk (5-yearly screening); HBA1c (42.0 to 46 mmol/mol)=high risk (screen annually); HBA1c (48 mmol/mol)=diabetes. Treat new diabetes and high-risk patients in accordance with national guidelinesMore studies on regional body fat distribution and on other potential mechanisms for greater diabetes risk. Effects on diabetes risk of lifestyle intervention in patients with psoriasis and PsA
NAFLDLFTsRefer for ultrasound or specialist management if LFTs >3 ULN or pattern associated with fibrosis risk (ie, AST>ALT). Lifestyle interventions in those with presumed or proven NAFLD; increased activity, reduced fat, reduced refined carbohydrate, increased fibre intake can reverse NAFLD and lower diabetes risks. Reduce alcohol intakeMore studies confirming NAFLD risk in patients with psoriasis and PsA. Effects of lifestyle interventions on NAFLD risk or progression in psoriasis and PsA. More on potential interaction between NAFLD and psoriasis for fibrosis risk
  • ALT, alanine transaminase; AST, aspartate aminotransferase; BMI, body mass index; CVD, cardiovascular disease; LFT, liver function test; NAFLD, non-alcoholic fatty liver disease; PsA, psoriatic arthritis; RCT, randomised controlled trial; ULN, upper limit of normal