Background/Purpose: Psoriatic arthritis (PsA) is present in about 30% of cutaneous psoriasis (PsO) patients. Both PsO and PsA are frequently associated to comorbidities that have important implications in the global approach of the psoriatic disease. In PsO, metabolic syndrome (MetS) is associated with disease severity and in PsA the relationship with MetS is likely linked to the underlying chronic inflammatory process. Although MetS is common in PsA, there are no data regarding its prevalence and association with disease activity in brazilian patients. Therefore our objectives were to evaluate the prevalence of MetS, associated comorbidities and correlate findings with some parameters of disease activity in a cohort of Brazilian patients with PsA from a single tertiary center.

Methods:  One hundred and one PsA patients regularly followed-up at our outpatient rheumatology clinic during the period of October 2013 to April 2014 were evaluated. All patients were assessed for obesity by measurement of body mass index, functional impairment by HAQ, physical activity practice and the presence of comorbidities including arterial hypertension, diabetes, dyslipidemia, MetS and non-alcoholic fatty liver disease ( NAFLD) by abdominal  ultrasound. The NCEP-ACT III criteria were used to identify subjects with MetS while DAS 28, BASDAI and ASDAS to evaluate PsA disease activity. Student’s t-test, Chi-square and Fisher’s exact tests were performed for statistical analyses and P values ≤ 0.05 were considered significant.

Results:  Gender proportion was similar with 49 males (48.5%) and 52 females (51.5%), mean age = 54.8+-13yrs (range 26-85yrs) and mean disease duration = 14.4+-8.1yrs (range 04-44yrs). Only 25% PsA patients had normal weight and 75% were overweight. The majority were sedentary (74%),  in one third of them (28%) due to joint pain though not associated to worse HAQ score (p=0.7). Half patients (50/101=49.5%) had MetS, with comparable frequencies in both genders and regardless of types of cutaneous PsO involvement. Overall prevalence of arterial hypertension was 49%, dyslipidemia 58%, diabetes 22%, obesity 31% and NAFLD 62%, significantly higher in patients with MetS in comparison to those without MetS (76%vs.23%; 68%vs.27%; 40%vs.4%; 52%vs.9%; 83%vs.22% respectively) (p=0.001). Interestingly, the prevalence of MetS was lower in axial PsA subjects  compared to those without axial manifestation (28%vs.49%, p=0.03), and no difference was observed among other PsA subtypes (p>0.05). Further analysis of patients with vs. without MetS revealed that those with MetS used less non-steroidal anti-inflammatory drugs (NSAIDs) (52%vs.74%, p= 0.019), less leflunomide (6%vs.20%, p=0.041) and had higher DAS 28 scores (3.1vs.2.8, p=0.025). Mean HAQ scores were for patients with and without MetS [(0.8 (0.5-2.3) vs. 1(0-3)p=0.4]

Conclusion: The considerable prevalence of MetS in patients with PsA associated to peripheral joint disease activity strengthens a common inflammatory pathway for both conditions. Early disease management including specific therapy allied to lifestyle changes and weight loss, not only to reduce comorbidities, but also to improve disease control, is mandatory.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/metabolic-syndrome-in-patients-with-psoriatic-arthritis-is-associated-to-peripheral-disease-activity/