Introduction: #Psoriasis is a chronic immune-mediated inflammatory dermatosis associated with systemic comorbidities, including metabolic disorders, atherosclerosis, and increased cardiovascular mortality.
Objectives: To evaluate the impact of #methotrexate (MTX) on clinical manifestations of psoriasis, lipid profile, endothelial function, nitric oxide bioavailability, and pro-inflammatory biomarkers.
Methods: This prospective, open-label pilot study assessed patients before and after 12 weeks of MTX therapy (15 mg/week). Endothelial function was evaluated by flow-mediated dilation (FMD1 and FMD2). Nitric oxide bioavailability was estimated by nitrate and nitrite (NOx) levels. Pro-inflammatory biomarkers analyzed included gasdermin D (GSDMD), interleukin-1β (IL-1β), NLRP3 inflammasome, LOX-1 receptor, and VCAM-1. Clinical outcomes (PASI, BSA, DLQI) and laboratory parameters were also assessed.
Results: Among 242 screened patients, 29 completed the study. After 12 weeks, significant clinical improvement was observed (PASI, BSA, DLQI; p < 0.001), along with reductions in LDL, total cholesterol, and non-HDL cholesterol (p ≤ 0.024). No significant changes were found in endothelial function, NOx levels, or inflammatory biomarkers.
Conclusion: MTX improved psoriasis severity and lipid profile without affecting endothelial function or inflammatory biomarkers. It appears cardiovascularly safe in patients without baseline endothelial dysfunction, though longer studies are needed.
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