Background/Purpose: Patients with PsA were reported to have a higher incidence of cardiovascular disease (CVD) and subclinical carotid atherosclerosis due to underlying inflammation. Minimal disease activity (MDA) is a validated treatment target for managing PsA. While achieving MDA was associated with benefits in articular disease, it’s effect on co-morbidities including CVD risk remained uncertain. This study aimed to investigate the effect of achieving sustained MDA on subclinical atherosclerosis evaluated by carotid intima-media thickness (IMT).

Methods: 100 PsA patients without overt CVD were recruited. Patients were followed for 2 years with clinical assessment every 4 months. Treatment was guided by a standardized protocol aiming at MDA. Sustained MDA(sMDA) was defined as achieving MDA at each visit from month 4 to 12. Carotid IMT were evaluated at baseline, month 12 and 24 using a high-resolution B-mode ultrasound machine. IMT was calculated based on the measurements at bilateral distal, bulb and proximal internal carotid artery.

Results: This is an interim analysis of the ongoing study. 51 PsA patients [male: 27 (52.9%); 50 ±12 years] who completed 12 months follow-up were analyzed. After 1 year of intensive treatment, significant improvement in disease activity [DAPSA: 15 (10,21) at baseline to 5 (2, 10) at 12 months (p<0.001)] was observed, and a significantly higher proportion of patient achieved MDA [8 (15.7%) at baseline vs 28 (54.9%) at 12 months p<0.001]. Mean carotid IMT increased significantly from 0.620 mm ±0.112 to 0.654 mm ±0.120 (p=0.04). 11/51 (21.6%) patients achieved sustained MDA. Baseline disease activity measures (PASI and DAPSA) and HAQ scores were lower in sMDA group. At 12 months, the mean carotid IMT were significantly lower in the sMDA group than the non-sMDA group [0.612±0.049mm vs 0.668±0.130mm (p=0.030)] while no significant changes were observed in the maximum IMT. Baseline mean carotid IMT was associated with month 12 mean carotid IMT (p<0.001). Using ANCOVA, the adjusted mean carotid IMT remained significantly lower in the sMDA group (0.612±0.023 mm vs 0.666±0.012 mm respectively, p=0.041) after adjusting for baseline mean carotid IMT (Table 1). There was also a significant difference in the change in mean IMT (-0.01± 0.08mm in sMDA group, vs 0.05± 0.08mm in non-sMDA group, p=0.046). The results remained significant when the changes were expressed as percentage changes of the baseline mean IMT (-0.1± 10.6% vs 7.9± 11.7%, p=0.046). The differences were statistically insignificant after adjusting for baseline differences probably due to small number. No significant changes were observed in the change in maximum IMT.

Conclusion: Effective suppression of inflammation by achieving sustained MDA may prevent progression of subclinical atherosclerosis in PsA patients Table 1 Changes in Carotid IMT over a 12 month period in patients who can or cannot achieve sustained MDA

* Adjusted for baseline HAQ, PASI and DAPSA

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/can-achieving-sustained-minimal-disease-activity-mda-prevent-progression-of-subclinical-atherosclerosis-a-prospective-cohort-study-in-psoriatic-arthritis/