SOURCE: Gyldenlove M, et al. J Am Acad Dermatol 2015;72:599-605.

The pathophysiology of psoriasis has much in common with rheumatoid arthritis (RA). Recently, pharmacotherapies that had been primarily used in RA have enjoyed successful application in psoriasis, leading to marked improvements or even remission. Of concern, both RA and psoriasis have been recognized as risk factors for cardiovascular disease. Psoriasis is also a risk factor for diabetes, but the mechanism remains ill-defined.

A consistent finding in patients with type 2 diabetes is the presence of insulin resistance, usually associated with obesity. Might psoriasis also be associated with insulin resistance, independent of obesity? To answer this question, Gyldenlove et al compared psoriatic patients with controls of similar age (mean = 44 years) and BMI (mean = 26, [overweight]), all of whom had undergone laboratory screening (fasting glucose and A1c) to exclude undiagnosed diabetes.

Insulin sensitivity was substantially reduced in patients with moderate-to-severe psoriasis compared to controls, even though there was no manifest glucose intolerance. Hence, psoriasis might be considered a pre-diabetic state.