Background/Purpose: Objectives. The addition of carotid ultrasound CU into composite cardiovascular risk (CVR) scores has been found useful in the identification of high CVR in patients with inflammatory arthritis. We aim to evaluated if the performance of CU in the CVR stratification of patients with psoriatic arthritis (PsA) would identify patients in the very-high SCORE risk category and if this reclassification could be explained through features related to disease activity.

Methods: A cross-sectional study including a set of 206 patients fulfilling CASPAR criteria for PsA and 179 controls was performed. The following data were assessed: lipid profile; Systematic Coronary Risk Evaluation  SCORE risk stratification; disease activity indexes through Disease Activity in Psoriatic Arthritis -DAPSA-, Bath Ankylosing Spondylitis Disease Activity -BASDAI-, Bath Ankylosing Spondylitis Functional Index -BASFI., skin disease activity measurements by Psoriasis Area Severity Index -PASI-, Body Surface Area -BSA-, and Nail Psoriasis Severity Index -NAPSI- scores; and the presence of carotid plaques and carotid intima media thickness (cIMT) trough ultrasound. A multivariable regression analysis, adjusting for classic cardiovascular risk factors, was performed in order to evaluate if risk reclassification following (CU) could be explained by features related to the disease and independently of traditional CVR factors.

Results: 49% patients with PsA had carotid plaques compared to 26% in controls (p=0.000). Similarly, cIMT was found to be higher in patients in comparison with controls (0.606 ± 0.116 vs. 0.679 ± 0.165, p=0.000). 51% of the patients were reclassified into a very-high SCORE risk category after carotid ultrasound compared to controls (26%, p=0.000). Principally, patients in the low SCORE category risk were significantly more reclassified (14% vs. 30%, p=0.002). Age (p=0.000), hypertension (p=0.000), obesity (p0.011), the use of statins (p=0.000), disease duration (p=0.000), and DAPSA score (p=0.049) were the variables that positive and univariately were associated with reclassification in PsA patients. Interestingly, PsA patients being reclassified disclosed lower total cholesterol (197 ± 36 vs. 179 ± 40 mg/dl, p=0.001) and LDL cholesterol serum levels (116 ± 35 vs. 106 ± 34 mg/dl, p=0.032) compared to controls. When the association of disease relation data with reclassification was assessed through multivariable regression, DAPSA score was associated with a higher probability of being reclassified (beta coef. 1.09 [95%CI 1.01-1.18]), p=0.035) after adjusting for age and traditional (CVR) factors. This relation was also found using DAPSA score. In this sense, a moderate or high activity category disclosed an odds ratio of 13.09 (95%CI 1.44-1118.76), p=0.022, compared to those patients in the low activity

Conclusion: Patients with PsA are more frequently reclassified into the very-high SCORE risk category after carotid ultrasound performance compared to controls. This reclassification can be independently explained by the activity produced by the disease

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disease-activity-influences-cardiovascular-risk-reclassification-based-on-carotid-ultrasound-in-patients-with-psoriatic-artrhitis/