Assessment of Cardiovascular risk and psychological comorbidities among patients with plaque psoriasis 

Introduction 
Psoriasis is a chronic inflammatory skin disease with significant systemic implications including psychological distress, impaired quality of life, and cardiovascular comorbidities. Methotrexate (MTX), a cornerstone in psoriasis treatment, has been proposed to exert cardioprotective effects through its anti-inflammatory properties. Local data on psoriasis-specific validated tools, interplay between psoriasis, comorbidities, and MTX therapy remain limited. 

Objectives 
To evaluate psychological, disability, and cardiovascular comorbidities in patients with plaque psoriasis, validate selected psoriasis-specific assessment tools, and examine the association between methotrexate therapy and cardiovascular risk markers.

Methods  
A multi-component study was conducted among patients with plaque psoriasis attending dermatology clinics in Sri Lanka. Sinhala versions of the Psoriasis Epidemiology Screening Tool (PEST) and Psoriasis Disability Index (PDI) were validated for reliability and construct validity. Psychological distress, depression, and quality of life were assessed using validated questionnaires, while disease  severity was assessed using standard clinical indices. Cardiovascular risk factors were evaluated using anthropometric and biochemical measurements, comorbidity indices, and established cardiovascular risk scores in comparison with neighbourhood controls. In addition, cardiovascular risk markers, metabolic syndrome prevalence, and safety profiles were compared between patients receiving  methotrexate and MTX-naïve patients. Data were analysed using appropriate descriptive and multivariate statistical methods. 

Results 
Validated Sinhala PEST and PDI showed good reliability and construct validity. Psychological morbidity and quality-of-life impairment were common, particularly in patients with more severe disease and joint symptoms. Patients with psoriasis had greater comorbidity burden and higher prevalence of dyslipidaemia compared with controls, although overall cardiovascular risk scores were similar.  Patients receiving methotrexate showed more favourable metabolic parameters and lower prevalence of metabolic syndrome, while overall cardiovascular risk scores and inflammatory markers were comparable between groups, with no major safety concerns.

Conclusion  
Patients with plaque psoriasis demonstrate a substantial psychological, metabolic, and cardiovascular comorbidity burden, supporting the need for comprehensive assessment. The validated Sinhala PEST and PDI provide useful tools for clinical practice in Sri Lanka. Although methotrexate use was associated with favourable metabolic profiles, the observational design limits causal inference, and  cardioprotective effects should be interpreted cautiously. This study provides one of the first integrated  evaluations of psychological and cardiovascular comorbidity in Sri Lankan patients with psoriasis and highlights the importance of a multidisciplinary approach to psoriasis care