In an illuminating advance for psoriasis research, new findings published in the Journal of Investigative Dermatology reveal that residual inflammation persists in a substantial subset of psoriasis patients undergoing biologic therapy—even when skin symptoms are markedly improved. This lingering inflammation extends beyond the skin and is closely associated with obesity, fatty liver disease, and systemic metabolic dysfunction, emphasizing the urgent need to shift treatment paradigms toward addressing psoriasis as a complex systemic disease rather than a condition confined to the skin.
Psoriasis has long been recognized as an immune-mediated skin disorder characterized by erythematous plaques and scaling. However, its systemic inflammatory nature is gaining increased attention for its role in exacerbating comorbidities such as cardiovascular disease, metabolic syndrome, and liver pathology. This new study systematically quantifies "residual inflammation" in patients with well-controlled skin disease under biologic treatments, using advanced imaging techniques and biochemical markers that expose the underlying inflammatory burden beyond visible symptoms.
The research team, led by Dr. Álvaro González-Cantero of the Hospital Universitario Ramón y Cajal in Madrid, implemented a prospective observational design involving 209 patients pooled from three international cohorts spanning Spain, the United States, and Sweden. All participants demonstrated a Psoriasis Area Severity Index (PASI) score of 2 or below, indicating minimal clinical skin disease. Nevertheless, a striking 36.3% displayed signs of residual inflammation detected through comprehensive systemic assessments including positron emission tomography/computed tomography (PET/CT) scans that highlighted metabolically active inflamed tissue, and blood tests quantifying inflammatory mediators.
The study’s revelations firmly establish a connection between residual inflammation and metabolic health indicators. Elevated body mass index (BMI), increased visceral and subcutaneous adiposity, and metabolic dysfunction-associated steatotic liver disease (MASLD)—a spectrum of fatty liver disease—which often parallels non-alcoholic fatty liver disease in clinical manifestation, were all significantly correlated with persistent inflammatory activity. This suggests that adipose tissue itself functions as an active immunological organ, driving chronic inflammation through cytokine release and metabolic dysregulation, thus perpetuating a vicious cycle of systemic insult despite dermatologic improvement.
Dr. González-Cantero emphasizes the clinical implications: “Although biologics effectively suppress cutaneous symptoms, a substantial subset of patients harbor systemic inflammation that could predispose them to serious cardiometabolic complications. Our findings call for a paradigm shift in psoriasis management, advocating for integrated care models that simultaneously target obesity, liver pathology, and systemic inflammatory burden to truly optimize patient outcomes.”
Complementary insights offered by co-first author Dr. Alba Lecumberri underline the cardiometabolic risk embedded in psoriasis beyond mere skin assessment. Close monitoring of inflammatory biomarkers such as high-sensitivity C-reactive protein (hsCRP), coupled with hepatic function evaluations, could enable earlier identification of high-risk patients. The incorporation of lifestyle interventions focused on weight management, tailored exercise programs, and dietary modifications rich in anti-inflammatory nutrients could potentially mitigate this insidious residual inflammation, thereby forestalling the development or progression of cardiovascular and metabolic complications.
The study’s methodology stands out for its rigorous cross-validation across three diverse international patient cohorts, lending robustness and generalizability to the findings. PET/CT imaging provided a sophisticated metric of inflammatory activity within adipose and hepatic tissues, while clinical and biochemical data allowed for nuanced correlation analyses. This multidisciplinary approach sets a new standard for researching systemic inflammation in psoriasis, reinforcing the concept that skin clearance is not synonymous with systemic remission.
Expert commentary from Dr. Michael Garshick, an authority in cardiometabolic health at New York University Grossman School of Medicine, contextualizes the findings within broader clinical practice: “Dermatologists and rheumatologists are uniquely positioned to recognize the intersection between psoriasis and cardiometabolic risk. This study underscores the utility of hsCRP testing to stratify those patients who might benefit from aggressive lipid management and weight reduction strategies, improving long-term health trajectories.”
Further elucidating the terminology introduced by this research, co-first author Dr. Emilio Berna-Rico highlights the significance of formally defining ‘residual inflammation’ within psoriasis. This concept acknowledges the persistent systemic immune activity that remains despite apparent clinical remission of skin lesions. Recognizing and naming this phenomenon opens new avenues for research and innovation in therapeutic interventions aimed at holistic disease control.
Moreover, Dr. Joel M. Gelfand of the University of Pennsylvania accentuates the clinical urgency encapsulated by these findings: “The skin is only the visible tip of the iceberg in psoriatic disease. Residual systemic inflammation, undetectable by standard dermatologic evaluations, quietly perpetuates cardiovascular and metabolic risks. Comprehensive treatment paradigms must evolve to incorporate approaches that directly target systemic inflammation.”
The broader scientific community is urged to pursue longitudinal studies that track the trajectory of residual inflammation during and after biologic therapies, integrating emerging biomarkers and innovative imaging technologies. Such efforts would better delineate the long-term impact of residual systemic immune activation on morbidity and mortality in psoriasis patients and inform tailored intervention strategies.
This groundbreaking research not only illuminates a critical blind spot in psoriasis management but also galvanizes a more holistic vision of patient care that transcends cutaneous symptoms. It advocates for an integrative therapeutic framework encompassing immunologic, metabolic, and lifestyle factors to mitigate systemic inflammation. The ultimate goal is to improve quality of life and reduce premature mortality associated with chronic inflammatory burden in psoriasis.
In sum, this study redefines our understanding of psoriasis by exposing the systemic inflammatory processes that persist despite skin clearance with biologics. It challenges clinicians and researchers alike to reconceptualize psoriasis treatment beyond epidermal signs and to address the metabolic and cardiovascular vulnerabilities informed by residual inflammation. Such insights herald a new era of precision medicine in dermatology, where managing psoriasis means curing the patient, not just the skin.
Subject of Research: People
Article Title: Residual Inflammation in Patients with Psoriasis Treated with Biologic Therapy: Findings from 3 Prospective Observational Cohorts
News Publication Date: 20-May-2025
Web References:
DOI: 10.1016/j.jid.2025.03.014
Image Credits: Journal of Investigative Dermatology / González-Cantero et al.
Keywords: Psoriasis, Residual Inflammation, Biologic Therapy, Systemic Inflammation, Obesity, Fatty Liver Disease, Metabolic Dysfunction, Cardiovascular Risk, Psoriasis Area Severity Index, Inflammatory Biomarkers, PET/CT Imaging, Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
