银屑病关节炎合并糖尿病的免疫代谢交互机制与临床管理策略

The Immunometabolic Interaction Mechanisms and Clinical Management Strategies of Psoriasis Arthritis Complicated with Diabetes Mellitus

摘要: 银屑病关节炎(PsA)是与银屑病有关的慢性炎性关节病变。其患者群体中2型糖尿病(T2DM)的共病率显著高于一般人群。这两种疾病共存的核心机制涉及免疫功能障碍与代谢失调之间的双向调控：胰岛素抵抗(IR)可通过激活促炎信号通路加重关节炎症；反之，PsA相关的系统性慢性炎症亦会损害胰岛β细胞功能，加剧糖代谢异常，从而形成“免疫–代谢循环”。临床管理需协同控制炎症与血糖，优先选用兼具抗炎与降糖效应的药物，并结合生活方式干预。本文旨在讨论PsA与T2DM共病状态下的交互机制及个体化治疗策略，以期为临床实践提供理论支持。

Abstract: Psoriatic arthritis (PsA) is a chronic inflammatory joint disorder associated with psoriasis. The comorbidity rate of type 2 diabetes mellitus (T2DM) in PsA patients is significantly higher than that in the general population. The core mechanism underlying the coexistence of these two diseases involves the bidirectional regulation between immune dysfunction and metabolic disorders: insulin resistance (IR) can exacerbate joint inflammation by activating pro-inflammatory signaling pathways; conversely, the systemic chronic inflammation associated with PsA can also impair the function of pancreatic β-cells and worsen glucose metabolism abnormalities, thereby forming an “immune-metabolic cycle”. Clinical management requires the coordinated control of inflammation and blood glucose, giving priority to drugs with both anti-inflammatory and glucose-lowering effects, combined with lifestyle interventions. This article aims to discuss the interaction mechanism and individualized treatment strategies in the comorbid state of PsA and T2DM, in order to provide theoretical support for clinical practice.