Psoriasis-associated lung disease: A comprehensive review and case series - 22/10/25

Doi : 10.1016/j.rmed.2025.108285

Stephen Mitchell ^a,^⁎ , Jessica A. Peterson ^b,^c, Mason Seely ^d, Hanzhi Gao ^e, Bruno Hochhegger ^f, Divya C. Patel ^a, Catalina Sanchez-Alvarez ^g,^h, Ann D. Chauffe ^g,ⁱ, Diana C. Gomez-Manjarres ^a,^c
^a Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL, USA
^b Department of Kinesiology, New Mexico State University, Las Cruces, NM, USA
^c North Florida Foundation of Research and Education, Malcom Randall Veteran Affairs Medical Center, Gainesville, FL, USA
^d Division of Internal Medicine, University of Florida College of medicine, Gainesville, FL, USA
^e Department of Biostatistics, University of Florida, Gainesville, FL, USA
^f Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
^g Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, Gainesville, FL, USA
^h Division of Rheumatology, Mayo Clinic School of Medicine, Rochester, MN, USA
ⁱ Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT, USA

^⁎Corresponding author. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, USA.Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of Florida College of Medicine1600 SW Archer RoadGainesvilleFLUSA

Abstract

Background

Psoriasis is a chronic systemic autoimmune disease primarily affecting the skin and joints. Growing evidence suggests an association with pulmonary comorbidities, though lung involvement remains under characterized. We reviewed the literature and conducted a retrospective analysis to define pulmonary manifestations in psoriasis patients, termed Psoriasis-Associated Lung Disease (Psoriasis-LD).

Methods

We identified 251 adult psoriasis patients at our academic center (2012–2022) who had chest CT scans and/or pulmonary function tests (PFTs). Data included demographics, psoriasis phenotype/treatment, respiratory symptoms, PFTs, radiographic features, and outcomes. Psoriasis-LD was defined by symptoms and/or CT abnormalities and/or abnormal PFTs. CT findings were categorized as: fibrotic (traction bronchiectasis/honeycombing), airway disease (bronchial wall thickening/bronchiectasis), or ground-glass opacities (GGO)/consolidation. Statistical analyses included descriptive statistics, group comparisons, Kaplan–Meier, and Cox proportional hazards models.

Results

The mean patient age was 64.6 ± 14.7 years, with an equal gender distribution (50 % female). Common comorbidities included obesity, gastroesophageal reflux disease (GERD), and sleep apnea. CT abnormalities included pulmonary ground-glass opacification or consolidation (25.1 %), airway disease (8–9 %), and interstitial fibrosis (3–7 %), with over half of the patients displaying any one of these features. Airway disease and GGO were strongly linked to death or transplant (HR 2.07, 2.50, respectively). Follow-up showed that 39 % of patients died or received lung transplants. Interstitial lung disease (ILD) was confirmed in 8.8 %, mainly NSIP and UIP patterns and most patients with ILD had additional risk factors.

Conclusion

Pulmonary abnormalities frequently occur in psoriasis patients and correlate with poorer outcomes, suggesting that psoriasis may be a significant risk factor for pulmonary complications. Earlier detection and multidisciplinary management are essential to improving patient outcomes.

Le texte complet de cet article est disponible en PDF.

Highlights

•	Lung disease seen in 50 % of psoriasis patients with chest CT imaging.
•	Airway disease and GGO were associated with increased mortality.
•	ILD was identified in 9 % of psoriasis patients but majority had other risk factors.
•	Respiratory symptoms predicted worse outcomes in psoriasis patients.

Le texte complet de cet article est disponible en PDF.

Keywords : Psoriasis, Pulmonary function, Computed tomography, Pulmonary conditions, Interstitial lung disease