Background/Purpose

Recent evidence supports the link between the extent of inflammation and cardiovascular risk in patients with psoriatic disease (PsD). We aimed to investigate the association between Human-Leukocyte Antigen (HLA) markers of severe phenotype and the extent of atherosclerosis in PsD.

Methods

Consecutive Caucasian patients with Psoriatic arthritis (PsA) and psoriasis alone (PsC) were recruited from two large cohorts. Patients with PsA met the CASPAR criteria. Patients with PsC were examined by a rheumatologist to exclude the presence of arthritis. Information about the participants’ demographics, co-morbidities and skin and joint disease activity was obtained from the cohorts’ database. An ultrasound of the carotid arteries was performed and the presence of atherosclerotic plaques was recorded. The size of each plaque was measured and the resulting score, the total plaque area (TPA), represented the extent of atherosclerosis. TPA was classified to 4 categories (No plaques, mild, moderate and severe atherosclerosis). HLA genotyping was performed by sequence-specific oligonucleotide probes. Haplotype information was inferred using an expectation–maximization algorithm. Ten HLA alleles that were previously reported to be associated with severe phenotype of PsD were analyzed. The association between each HLA allele and the severity of atherosclerosis was assessed by ordinal logistic regression models adjusted for age, sex and traditional cardiovascular risk factors.

Results

411 patients with PsD (273 PsA, 138 PsC) were analyzed. Their mean age was 55.5±11.5 years and 55.7% were males. 254 (61.8%) had at least one atherosclerotic plaque. HLA-B*1302 and HLA-C*0602 were associated with more severe atherosclerosis (age- and sex-adjusted Odds Ratio (OR) 2.31 (95% Confidence Interval (CI) 1.23, 4.32) and OR 1.68 (95% CI 1.12, 2.52), respectively). The haplotype HLA-B*1302-C*0602 was also associated with more severe atherosclerosis (OR 2.49, 95% CI 1.32, 4.72). The association between HLA-C*0602 and B*1302 and atherosclerosis severity remained statistically significant after adjusting for traditional cardiovascular risk factors (OR 1.63 (95% CI 1.08, 2.45) and OR 2.21 (95% CI 1.17, 4.16), respectively). Lower extent of atherosclerosis was found in carriers of HLA-B*3801 allele and the HLA-B*3801-C*1203 haplotype (age- and sex-adjusted OR 0.49 (95% CI 0.28, 0.86) and OR 0.45 (95% CI 0.26, 0.80), respectively). Higher levels of erythrocyte sedimentation rate over time were associated with HLA-B*1302 (p=0.02) and HLA-C*0602 (p=0.0007). No association was found between these alleles and traditional cardiovascular risk factors. No interaction was found between the HLA alleles and disease status.

Conclusion

HLA-C*0602 and B*1302 are markers of more severe atherosclerosis, while HLA-B*3801 is associated with lower burden of atherosclerosis in patients with PsD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hla-markers-for-disease-severity-are-associated-with-a-higher-burden-of-atherosclerosis-in-patients-with-psoriatic-disease/