Integrated approach to hyperuricemia, gout, and cardiometabolic risk in psoriatic disease.
| Step | Focus | Key actions |
|---|---|---|
| 1. Risk identification and baseline evaluation | PsA patients with ↑ BMI, metabolic comorbidities, or active disease | Assess SUA, lipids, BP, HbA1c, inflammatory markers, PASI/DAPSA, eGFR, and waist circumference |
| 2. Management of gout | If gout present | Start ULT (allopurinol/febuxostat); SUA target < 6 mg/dL; flare prophylaxis (colchicine/NSAIDs); note: no CV prevention with ULT |
| 3. Weight and metabolic health | Obesity and systemic inflammation | GLP-1 RAs, tirzepatide + lifestyle; benefits: weight ↓, inflammation ↓, modest SUA ↓ |
| 4. Vascular risk management | CV prevention | Treat LDL, BP, smoking; statins if high risk (LDL < 70 mg/dL); SGLT2i for DM: SUA ↓, renal and vascular benefit |
| 5. Integrated care approach | Multidisciplinary | Coordinate with cardiology/PCP; monitor SUA, weight, inflammation, lipids; combine GLP-1/GIP + traditional medicines |
| 6. Monitoring and follow-up | Long-term | Track SUA, weight, PASI/DAPSA; maintain ULT if active gout persists despite weight loss |
PsA: psoriatic arthritis; BMI: body mass index; SUA: serum uric acid; BP: blood pressure; HbA1c: glycated hemoglobin; PASI: Psoriasis Area and Severity Index; DAPSA: Disease Activity in Psoriatic Arthritis; eGFR: estimated glomerular filtration rate; ULT: urate-lowering therapy; CV: cardiovascular; GLP-1 RAs: glucagon-like peptide-1 receptor agonists; GIP: glucose-dependent insulinotropic polypeptide; SGLT2i: sodium-glucose cotransporter-2 inhibitors; PCP: primary care physician; ↑: increased; ↓: reduction/diminishing.