Interstitial lung disease in psoriasis: A systematic review and meta-analysis

Interstitial lung disease in psoriasis: A systematic review and meta-analysis

Authors

  • Jonas A. Baekdal Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Denmark https://orcid.org/0000-0001-5414-6732
  • Laura Bjerken Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Denmark
  • Erik Sören Halvard Hansen Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Denmark
  • Laurits K. Janns Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Denmark
  • Howraman Meteran Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Denmark
  • Charlotte Suppli Ulrik Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  • Elisabeth Bendstrup Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

Keywords:

interstitial lung disease, psoriasis, psoriatic arthritis, psoriasis vulgaris, usual interstitial pneumonia

Abstract

Background and aim: Psoriatic disease is associated with several extra-cutaneous complications, including cardiovascular disease and type 2 diabetes. Whether psoriatic disease is associated with interstitial lung disease (ILD) remains uncertain. The aim of this study was toquantify the prevalence of ILD overall and across specific subtypes of psoriatic disease.

Methods: We systematically searched PubMed, Embase, and Scopus for original studies reporting the prevalence of ILD in adults with psoriatic disease. Pooled prevalence estimates were calculated using proportional random-effects meta-analysis, with subgroup analyses stratified by factors including psoriatic disease type, sex, and smoking history. Random-effects meta-regression was conducted to examine the influence of age and disease duration.

Results: Of 863 records screened, 11 studies were included. The pooled ILD prevalence in any psoriatic disease was 3.6% (95% CI: 2.1–5.0%). Meta-regression indicated that ILD prevalence increased by 0.19 percentage points per year (95% CI: 0.16–0.22) from approximately 38 years of age. Subgroup analysis showed ILD prevalences of 2.4% (95% CI: 1.1–3.6%) in psoriasis vulgaris, 5.7% (95% CI: 2.5–8.9%) in psoriatic arthritis, and 8.4% (95% CI: 6.4–10.4%) in generalized pustular psoriasis (GPP). ILD prevalence was 1.2% (95% CI: 0.1–2.2%) in never-smokers versus 6.7% (95% CI: 2.3–11.1%) in ever-smokers.

Conclusions: ILD may represent a clinically relevant comorbidity in patients with psoriatic disease, particularly psoriatic arthritis and GPP. This increased prevalence may reflect chronic systemic inflammation and exposures such as medications and cigarette smoke. Further research is needed to elucidate the underlying mechanisms and to assess whether early detection and targeted interventions can improve outcomes

References

1. Parisi R, Symmons DPM, Griffiths CEM, Ashcroft DM, Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013 Feb;133(2):377–85. doi: 10.1038/jid.2012.339

2. Kishimoto M, Deshpande GA, Fukuoka K, et al. Clinical features of psoriatic arthritis. Best Pract Res Clin Rheumatol. 2021 Jun;35(2):101670. doi: 10.1016/j.berh.2021.101670

3. Osigwe PC, Agomoh CE, Osigwe IS, Akumiah FK. The association between psoriasis and atherosclerotic cardiovascular disease: a systematic review and meta-analysis of observational studies. Cureus. 2024 Jun;16(6):e63379. doi: 10.7759/cureus.63379

4. Mamizadeh M, Tardeh Z, Azami M. The association between psoriasis and diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr. 2019;13(2):1405–12. doi: 10.1016/j.dsx.2019.01.009

5. Morita A, Kotowsky N, Gao R, Shimizu R, Okubo Y. Patient characteristics and burden of disease in Japanese patients with generalized pustular psoriasis: results from the Medical Data Vision claims database. J Dermatol. 2021 Oct;48(10):1463–73. doi: 10.1111/1346-8138.16022

6. Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci. 2019 Mar 23;20(6). doi: 10.3390/ijms20061475

7. Oikonomou EK, Marwan M, Desai MY, et al. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet. 2018 Sep 15;392(10151):929–39. doi: 10.1016/S0140-6736(18)31114-0

8. Elnabawi YA, Oikonomou EK, Dey AK, et al. Association of biologic therapy with coronary inflammation in patients with psoriasis as assessed by perivascular fat attenuation index. JAMA Cardiol. 2019 Sep 1;4(9):885. doi: 10.1001/jamacardio.2019.2589

9. Suresh K, Shimoda LA. Lung circulation. Compr Physiol. 2016 Mar 15;6(2):897–943. doi: 10.1002/cphy.c140049

10. Joy GM, Arbiv OA, Wong CK, et al. Prevalence, imaging patterns and risk factors of interstitial lung disease in connective tissue disease: a systematic review and meta-analysis. Eur Respir Rev. 2023 Mar 31;32(167). doi: 10.1183/16000617.0210-2022

11. Konak HE, Atalar E, Hezer H, et al. Interstitial lung disease in primary Sjögren’s syndrome: risk factors for occurrence and radiographic progression. Sarcoidosis Vasc Diffuse Lung Dis. 2024 Sep 24;41(3):e2024035. doi: 10.36141/svdld.v41i3.15548

12. Kattih Z, Greenstein Z, Makkar P, Gupta R. Advanced interstitial lung disease: evidence-based management and clinical approach. Sarcoidosis Vasc Diffuse Lung Dis. 2025 Jun 25;42(2):16206. doi: 10.36141/svdld.v42i2.16206

13. Kwon BS, Choe J, Chae EJ, Hwang HS, Kim YG, Song JW. Progressive fibrosing interstitial lung disease: prevalence and clinical outcome. Respir Res. 2021 Oct;22(1):282. doi: 10.1186/s12931-021-01879-6

14. Mononen M, Saari E, Hasala H, et al. Reticulation pattern without honeycombing on high-resolution CT is associated with the risk of disease progression in interstitial lung diseases. BMC Pulm Med. 2022 Aug 14;22(1):313. doi: 10.1186/s12890-022-02105-9

15. Wang HF, Wang YY, Li ZY, He PJ, Liu S, Li QS. The prevalence and risk factors of rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis. Ann Med. 2024 Dec;56(1):2332406. doi: 10.1080/07853890.2024.2332406

16. Kawamoto H, Hara H, Minagawa S, et al. Interstitial pneumonia in psoriasis. Mayo Clin Proc Innov Qual Outcomes. 2018 Dec;2(4):370–7. doi: 10.1016/j.mayocpiqo.2018.07.006

17. Matsumoto Y, Abe N, Tobita R, et al. The risk of interstitial lung disease during biological treatment in Japanese patients with psoriasis. Clin Exp Dermatol. 2020;45(7):853–8. doi: 10.1111/ced.14259

18. Hünür M, Öğüt TS, Çelik E, et al. Lung involvement in patients with psoriatic arthritis. Arch Rheumatol. 2024 Dec;39(4):631–40. doi: 10.46497/ArchRheumatol.2024.10537

19. Hara H, Miyagawa H, Araya J, et al. Effect of anti-interleukin-17 biologics on Krebs von den Lungen-6 level in patients with psoriasis. J Dermatol. 2021 Jun;48(6):886–93. doi: 10.1111/1346-8138.15895

20. Kanaji N, Misaki N, Murota M, et al. Prevalence and clinical features of interstitial lung disease in patients with psoriasis. BMC Pulm Med. 2024 Dec;24(1):610. doi: 10.1186/s12890-024-03450-7

21. Özkarafakılı MA, Bardakçı Mİ, Sivaz O, Kıvanç Altunay İ. Unmasking pulmonary parenchymal changes in psoriasis patients: a radiological perspective. Medicina (Kaunas). 2025 Jan;61(2). doi: 10.3390/medicina61020196

22. Hagiwara S, Tsuboi H, Terasaki T, et al. Association of anti-cyclic citrullinated peptide antibody with clinical features in patients with psoriatic arthritis. Mod Rheumatol. 2020;30(2):365–72. doi: 10.1080/14397595.2019.1586085

23. Miyagawa H, Hara H, Araya J, et al. Characteristics of anti-IL-17/23 biologics-induced interstitial pneumonia in patients with psoriasis. PLoS One. 2021;16(1):e0245284. doi: 10.1371/journal.pone.0245284

24. Monosi B, Cristiano I, Capparelli E, et al. Lung involvement in psoriatic arthritis patients: cross-sectional study on prevalence, clinical characteristics, and risk factors of a neglected comorbidity. Clin Exp Rheumatol. 2025 Jan 20. doi: 10.55563/clinexprheumatol/iqfq8c

25. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71. doi: 10.1186/s13643-021-01626-4

26. Herzog R, Álvarez-Pasquin MJ, Díaz C, Del Barrio JL, Estrada JM, Gil Á. Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health. 2013 Feb 19;13:154. doi: 10.1186/1471-2458-13-154

27. Samrah SM, Qarqaz F, Obeidat O, Bataineh Z. Subclinical high-resolution chest CT scan features in psoriasis. Respir Med. 2023 Jun;212:107226. doi: 10.1016/j.rmed.2023.107226

28. Okubo Y, Kotowsky N, Gao R, Saito K, Morita A. Clinical characteristics and health-care resource utilization in patients with generalized pustular psoriasis using real-world evidence from the Japanese Medical Data Center database. J Dermatol. 2021 Nov;48(11):1675–87. doi: 10.1111/1346-8138.16084

29. Rizzetto G, Tagliati C, Fogante M, et al. CT patterns of interstitial lung disease in patients with plaque psoriasis: a retrospective case series study. Medicina (Kaunas). 2023 Sep 12;59(9). doi: 10.3390/medicina59091650

30. Kaul B, Cottin V, Collard HR, Valenzuela C. Variability in global prevalence of interstitial lung disease. Front Med (Lausanne). 2021;8:751181. doi: 10.3389/fmed.2021.751181

31. Rose JA, Menon AA, Hino T, et al. Suspected interstitial lung disease in COPDGene Study. Am J Respir Crit Care Med. 2023 Jan 1;207(1):60–8. doi: 10.1164/rccm.202203-0550OC

32. Engel A, Xie C, Summer R, Loizidis G. The risk of interstitial lung disease in psoriatic arthritis versus psoriasis: a retrospective nationwide database analysis (2014–24). Rheumatol Adv Pract. 2025 Jun 12;9(3). doi: 10.1093/rap/rkaf059

33. Provan SA, Ljung L, Kristianslund EK, et al. Interstitial lung disease in patients with rheumatoid arthritis or psoriatic arthritis initiating biologics and controls: data from 5 Nordic registries. J Rheumatol. 2024 Nov;51(11):1111–8. doi: 10.3899/jrheum.2024-0252

34. Husted JA, Thavaneswaran A, Chandran V, et al. Cardiovascular and other comorbidities in patients with psoriatic arthritis: a comparison with patients with psoriasis. Arthritis Care Res (Hoboken). 2011 Dec;63(12):1729–35. doi: 10.1002/acr.20627

35. Sugimoto E, Matsuda H, Shibata S, et al. Impact of pretreatment systemic inflammatory markers on treatment persistence with biologics and conventional systemic therapy: a retrospective study of patients with psoriasis vulgaris and psoriatic arthritis. J Clin Med. 2023 Apr 21;12(8). doi: 10.3390/jcm12083046

36. Sokolova MV, Simon D, Nas K, et al. A set of serum markers detecting systemic inflammation in psoriatic skin, entheseal, and joint disease in the absence of C-reactive protein and its link to clinical disease manifestations. Arthritis Res Ther. 2020 Feb 12;22(1):26. doi: 10.1186/s13075-020-2111-8

37. Karmacharya P, Wright K, Achenbach SJ, et al. Time to transition from psoriasis to psoriatic arthritis: a population-based study. Semin Arthritis Rheum. 2022 Feb;52:151949. doi: 10.1016/j.semarthrit.2021.12.013

38. Stock CJW, Bray WG, Kouranos V, et al. Serum C-reactive protein is associated with earlier mortality across different interstitial lung diseases. Respirology. 2024 Mar;29(3):228–34. doi: 10.1111/resp.14609

39. Baumgartner KB, Samet JM, Stidley CA, Colby TV, Waldron JA. Cigarette smoking: a risk factor for idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1997 Jan;155(1):242–8. doi: 10.1164/ajrccm.155.1.9001319

40. Margaritopoulos GA, Vasarmidi E, Jacob J, Wells AU, Antoniou KM. Smoking and interstitial lung diseases. Eur Respir Rev. 2015 Sep;24(137):428–35. doi: 10.1183/16000617.0050-2015

41. Antoniou KM, Walsh SL, Hansell DM, et al. Smoking-related emphysema is associated with idiopathic pulmonary fibrosis and rheumatoid lung. Respirology. 2013 Nov;18(8):1191–6. doi: 10.1111/resp.12154

42. Yang S, Wang J, Sun D, Wang Y, Xue C, Ye Q. Disease progression in patients with usual interstitial pneumonia and probable UIP patterns on computed tomography with various underlying etiologies: a retrospective cohort study. Front Med (Lausanne). 2023;10:1246767. doi: 10.3389/fmed.2023.1246767

43. Qiu M, Jiang J, Nian X, et al. Factors associated with mortality in rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis. Respir Res. 2021 Oct 11;22(1):264. doi: 10.1186/s12931-021-01856-z

44. Kim EJ, Elicker BM, Maldonado F, et al. Usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease. Eur Respir J. 2010 Jun;35(6):1322–8. doi: 10.1183/09031936.00092309

45. Kadura S, Raghu G. Rheumatoid arthritis-interstitial lung disease: manifestations and current concepts in pathogenesis and management. Eur Respir Rev. 2021 Jun 30;30(160). doi: 10.1183/16000617.0011-2021

46. Mura M, Rellini C, Taha N, et al. Radiographic progression and survival of the different HRCT patterns of idiopathic pulmonary fibrosis. Sarcoidosis Vasc Diffuse Lung Dis. 2022;39(2):e2022021. doi: 10.36141/svdld.v39i2.12534

47. Han MK, Murray S, Fell CD, et al. Sex differences in physiological progression of idiopathic pulmonary fibrosis. Eur Respir J. 2008 Jun;31(6):1183–8. doi: 10.1183/09031936.00165207

48. Zaman T, Moua T, Vittinghoff E, Ryu JH, Collard HR, Lee JS. Differences in clinical characteristics and outcomes between men and women with idiopathic pulmonary fibrosis: a multicenter retrospective cohort study. Chest. 2020 Jul;158(1):245–51. doi: 10.1016/j.chest.2020.02.009

49. Chen J, Chen Y, Liu D, et al. Predictors of long-term prognosis in rheumatoid arthritis-related interstitial lung disease. Sci Rep. 2022 Jun 8;12(1):9469. doi: 10.1038/s41598-022-13474-w

50. Gochuico BR, Avila NA, Chow CK, et al. Progressive preclinical interstitial lung disease in rheumatoid arthritis. Arch Intern Med. 2008 Jan 28;168(2):159–66. doi: 10.1001/archinternmed.2007.59

51. Chang SH, Jung S, Chae JJ, et al. Therapeutic single-cell landscape: methotrexate exacerbates interstitial lung disease by compromising the stemness of alveolar epithelial cells under systemic inflammation. EBioMedicine. 2024 Oct;108:105339. doi: 10.1016/j.ebiom.2024.105339

52. Mochizuki T, Ikari K, Yano K, Sato M, Okazaki K. Long-term deterioration of interstitial lung disease in patients with rheumatoid arthritis treated with abatacept. Mod Rheumatol. 2019 May;29(3):413–7. doi: 10.1080/14397595.2018.1481566

53. Rondon F, Mendez O, Spinel N, et al. Methotrexate-induced pulmonary toxicity in psoriatic arthritis (PsA): case presentation and literature review. Clin Rheumatol. 2011 Oct;30(10):1379–84. doi: 10.1007/s10067-011-1765-7

54. Salaffi F, Manganelli P, Carotti M, Subiaco S, Lamanna G, Cervini C. Methotrexate-induced pneumonitis in patients with rheumatoid arthritis and psoriatic arthritis: report of five cases and review of the literature. Clin Rheumatol. 1997 May;16(3):296–304. doi: 10.1007/BF02238967

55. Naureen S, Hart S, Jawad N, Kennan N, Faruqi S. Long term nitrofurantoin induced interstitial lung disease: a case series and literature review. Sarcoidosis Vasc Diffuse Lung Dis. 2023 Dec 20;40(4):e2023050. doi: 10.36141/svdld.v40i4.13827

56. Izhakian S, Rosengarten D, Pertzov B, et al. Sertraline-associated interstitial lung disease: a case series and literature review. Sarcoidosis Vasc Diffuse Lung Dis. 2021;38(3):e2021027. doi: 10.36141/svdld.v38i3.11363

57. Camus P, Fanton A, Bonniaud P, Camus C, Foucher P. Interstitial lung disease induced by drugs and radiation. Respiration. 2004;71(4):301–26. doi: 10.1159/000079633

58. Dawson JK, Quah E, Earnshaw B, Amoasii C, Mudawi T, Spencer LG. Does methotrexate cause progressive fibrotic interstitial lung disease? A systematic review. Rheumatol Int. 2021 Jun;41(6):1055–64. doi: 10.1007/s00296-020-04773-4

59. Juge PA, Lee JS, Lau J, et al. Methotrexate and rheumatoid arthritis associated interstitial lung disease. Eur Respir J. 2021 Feb;57(2). doi: 10.1183/13993003.00337-2020

60. Gutierrez M, Ruta S, Clavijo-Cornejo D, Fuentes-Moreno G, Reyes-Long S, Bertolazzi C. The emerging role of ultrasound in detecting interstitial lung disease in patients with rheumatoid arthritis. Joint Bone Spine. 2022 Nov;89(6):105407. doi: 10.1016/j.jbspin.2022.105407

61. Vermant M, Kalkanis A, Jacob J, et al. Lung ultrasound outperforms symptom-based screening to detect interstitial lung disease associated with rheumatoid arthritis. RMD Open. 2025 Feb;11(1). doi: 10.1136/rmdopen-2024-005283

62. Otaola M, Vasarmidi E, Ottaviani S, et al. Performance of Lung Ultrasound as a Screening Tool for Subclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Multicenter Study. Chest. 2024 Dec. doi: 10.1016/j.chest.2024.11.038

63. Sofíudóttir BK, Harders S, Laursen CB, et al. Detection of Interstitial Lung Disease in Rheumatoid Arthritis by Thoracic Ultrasound: A Diagnostic Test Accuracy Study. Arthritis Care Res (Hoboken). 2024 Sep;76(9):1294–302. doi: 10.1002/acr.25351

64. Antoniou KM, Distler O, Gheorghiu AM, et al. ERS/EULAR clinical practice guidelines for connective tissue diseases associated interstitial lung disease. Ann Rheum Dis. 2025 Sep 3. doi: 10.1183/13993003.02533-2024

65. Shih YCT, Bradley C, Yabroff KR. Ecological and individualistic fallacies in health disparities research. J Natl Cancer Inst. 2023 May 8;115(5):488–91. doi: 10.1093/jnci/djad047

Downloads

Additional Files

Published

27-03-2026

Issue

Section

Review

How to Cite

1.
Baekdal JA, Bjerken L, Hansen ESH, Janns LK, Meteran H, Ulrik CS, et al. Interstitial lung disease in psoriasis: A systematic review and meta-analysis. Sarcoidosis Vasc Diffuse Lung Dis [Internet]. 2026 Mar. 27 [cited 2026 Apr. 17];43(1):17851. Available from: https://mail.mattioli1885journals.com/index.php/sarcoidosis/article/view/17851