In this large postauthorization safety trial, investigators compared tofacitinib with TNF inhibitors in patients with active rheumatoid arthritis who were already taking methotrexate, 50 years of age or older, and had at least one additional cardiovascular risk factor. Patients were randomly assigned to receive tofacitinib 5 mg twice daily, tofacitinib 10 mg twice daily, or a TNF inhibitor, and were followed for a median of 4 years. The study’s main goal was to determine whether tofacitinib was not meaningfully worse than TNF inhibitors for major adverse cardiovascular events (MACE) and cancers other than nonmelanoma skin cancer. That benchmark was not met. Rates of both MACE and cancer were higher in the combined tofacitinib groups than in the TNF inhibitor group, with MACE occurring in 3.4% vs 2.5% of patients and cancers occurring in 4.2% vs 2.9%. These findings indicated that tofacitinib was associated with greater cardiovascular and malignancy risk in this enriched higher-risk population.

Beyond the coprimary safety outcomes, several additional adverse events also were reported more often with tofacitinib than with TNF inhibitors. These included opportunistic infections, herpes zoster, tuberculosis, and nonmelanoma skin cancer, adding to the overall safety concerns seen with the JAK inhibitor. Importantly, the study noted that efficacy was broadly similar across treatment groups, with clinical improvements appearing as early as Month 2 and remaining stable through the end of the trial. In other words, tofacitinib and TNF inhibitors delivered comparable disease control, but tofacitinib carried a less favorable safety profile in this specific patient population. Overall, the trial suggests that for older patients with rheumatoid arthritis and elevated cardiovascular risk, TNF inhibitors may offer a safer option than tofacitinib when balancing benefit and risk.

Reference: Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med. 2022 Jan 27;386(4):316-326. doi: 10.1056/NEJMoa2109927. PMID: 35081280.

Psoriasis is increasingly understood as a systemic inflammatory disease that is linked to a higher risk of nonalcoholic fatty liver disease (NAFLD), with patients who have both conditions often experiencing more severe psoriasis and greater risk of liver fibrosis. NAFLD ranges from simple fatty liver to nonalcoholic steatohepatitis (NASH), which can progress to fibrosis, cirrhosis, and even liver cancer. Because many patients are asymptomatic, NAFLD is often identified through mildly abnormal liver tests or imaging such as ultrasound, CT, or MRI. Liver biopsy remains the only way to distinguish simple fatty liver from NASH. The review highlights that patients with psoriasis are significantly more likely than controls to have NAFLD. This association appears to persist even after accounting for shared metabolic risk factors such as obesity and metabolic syndrome.

The article also stresses that recognizing NAFLD in patients with psoriasis matters because it can influence both broader health risk assessment and treatment selection. Lifestyle measures such as weight loss, exercise, reducing alcohol intake, and limiting saturated fats and high-fructose corn syrup may help improve liver health. Supplements such as vitamin D, vitamin E, and omega-3 fatty acids may offer some benefit in selected patients. Some early evidence suggests TNF-alpha inhibitors may improve liver-related markers, but larger studies are still needed. At the same time, certain psoriasis treatments, especially methotrexate, and potentially cyclosporine or acitretin, may worsen liver-related risks and should be used carefully in patients with NAFLD. Overall, the review argues that screening for fatty liver disease and tailoring psoriasis treatment accordingly may help reduce both hepatic and cardiometabolic complications.

Reference: Prussick R, Prussick L, Nussbaum D. Nonalcoholic Fatty liver disease and psoriasis: what a dermatologist needs to know. J Clin Aesthet Dermatol. 2015 Mar;8(3):43-5. PMID: 25852814; PMCID: PMC4382145.

Obesity is common in psoriatic arthritis (PsA), affecting up to 48% of patients, and appears to worsen disease burden through both inflammatory and mechanical pathways. This article explains that excess adipose tissue promotes low-grade systemic inflammation and releases proinflammatory mediators that may contribute to PsA pathogenesis. Added joint stress may further drive symptoms. In turn, functional limitations from PsA can reduce physical activity and contribute to additional weight gain. Clinically, obesity is associated with higher disease activity, multidrug treatment failure, and lower odds of reaching minimal disease activity (MDA), which may help explain why many patients do not meet treatment goals even after TNF inhibitor therapy.

The article also emphasizes that weight management is a modifiable factor that may improve outcomes in patients with active PsA and obesity. Current recommendations from GRAPPA, ACR, and EULAR support addressing obesity as part of PsA management, using approaches such as nutrition, exercise, behavioral support, pharmacotherapy, or bariatric surgery. Evidence cited includes studies showing that diet-based weight loss, especially at least 5% body weight reduction, is associated with higher likelihood of achieving MDA and with improvements in disease activity, pain, fatigue, and related outcomes. Overall, the message is that proactive attention to weight may help clinicians improve disease control and reduce the overall impact of PsA.

Reference: Lilly Medical Affairs. The Impact of Obesity on Psoriatic Arthritis. RheumNow. Published February 1, 2026. Accessed March 30, 2026.