A DIFFERENTIATED APPROACH TO THE PREVENTION OF OBESITY-ASSOCIATED METABOLIC SYNDROME IN PATIENTS WITH PSORIASIS: A LITERATURE REVIEW AND A PROPOSED ALGORITHM

Abstract

Relevance. Metabolic syndrome is more common in patients with psoriasis than in people without psoriasis, with more than twice the odds. Their coexistence is associated with increased cardiovascular risk and requires comprehensive prevention. Objective. To summarise current evidence on pathogenetic mechanisms, risk stratification tools and preventive interventions in obesity-associated metabolic syndrome in psoriasis, and to present the differentiated prevention algorithm we have developed. Materials and Methods. A narrative review considered publications from 2015–2026 identified in PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, eLibrary and Google Scholar. Sources included systematic and narrative reviews, meta-analyses, interventional and observational studies, Mendelian randomisation studies and clinical guidelines, together with the authors’ previously published research. Results. The association between psoriasis and metabolic disturbances is bidirectional; shared mechanisms include systemic inflammation, insulin resistance, adipokine imbalance and endothelial dysfunction. Mendelian randomisation studies support a causal effect of higher body mass index on psoriasis risk. In a meta-analysis of six randomised trials, weight reduction through diet or physical activity was associated with a mean PASI reduction of 2.59 points relative to controls. Based on the review and the authors’ research, an algorithm is proposed for patients with psoriasis and body mass index above 28 kg/m². A preliminary integral screening index defines three categories for the proposed intensity of preventive care; immunological and genetic assessments are considered research components. Conclusions. The proposed algorithm organises preventive measures and directions for further research into personalised care in psoriasis. Its ability to predict metabolic syndrome, clinical effectiveness and the value of additional assessments require prospective evaluation in an independent cohort.