Background/Purpose: Cardiovascular morbidity is increased in patients with psoriatic arthritis (PsA). Traditional cardiovascular risk factors do not fully explain this excessive risk. It is unclear whether the cumulative burden of inflammation in the skin and the joints contribute to the development of atherosclerotic plaques. We aimed to investigate whether higher burden of arthritis and psoriasis over time is associated with the development of atherosclerotic plaques among patients with PsA.

Methods: A retrospective cohort analysis was conducted in patients attending a large PsA clinic. Patients were assessed at 6-12 month intervals according to a standard protocol. Information about demographics, medical history, musculoskeletal and skin examination, patient-reported outcomes and laboratory tests was collected at each visit. The cumulative effect of inflammation was measured by a time-adjusted arithmetic mean (AM) of all available measurements from the first visit to the clinic. The following variables were considered as predictors: Psoriasis Activity and Severity Index (PASI), Erythrocyte Sedimentation Rate (ESR), total leukocyte counts (TLC), Tender and Swollen joint count (TJC, SJC), C – reactive protein (CRP), Psoriatic Arthritis Disease Activity Score (PASDAS) and Disease Activity for PsA (DAPSA). Ultrasound assessment of the carotid arteries was performed and Total Plaque Area (TPA) was measured. This measure represented the extent of atherosclerosis and was considered the outcome of interest. TPA was stratified into 4 categories: 1) TPA=0 (no plaques), 2) 02, 3) 0.12, 4) TPA>0.4 cm². The association between the various AM variables and TPA categories was assessed using logistic ordinal regression model adjusted age and gender.

Results: A total of 235 patients with PsA were analyzed. Their mean age was 55.4±11.4 years and the duration of psoriasis and PsA were 27±13.5 and 16.2±11.7 years, respectively. 56.6% of the participants were males. Patients in higher TPA categories were older at the time of assessment (p<0.001), were more likely to be smokers (p=0.008), hypertensive (p=0.002), diabetics (p<0.001) and were older at the onset of psoriasis (p<0.001) and PsA (p<0.001). In a multivariable regression model adjusted for age and sex AM-ESR was associated with higher TPA categories (category 3 vs. 1 Odds Ratio (OR) 1.04, 95% Confidence Interval (CI) 1, 1.08, p=0.04, category 4 vs. 1 OR 1.05, 95% CI 1.01, 1.1, p=0.02). The following variables were also associated with higher probability of having severe atherosclerosis (being in TPA category 4 vs. 1): AM-TLC (OR 1.45, 95% CI 1.09, 1.92, p=0.01) and AM-DAPSA (OR 1.08, 95% CI 1.02, 1.14, p=0.009). A trend for an association was observed between AM-PASDAS and being in the highest TPA category (OR 1.73, 95% CI 0.97, 3.09, p=0.06). No significant association was found between AM-PASI, AM-CRP, AM-TJC, AM-SJC and damaged joint count and TPA category in multivariate analysis. 

Conclusion: An exposure to increased cumulative inflammation is associated with development of atherosclerotic plaques among patients with PsA.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/cumulative-exposure-to-elevated-inflammatory-markers-is-associated-with-increased-burden-of-atherosclerosis-in-psoriatic-arthritis-patients-a-cohort-study/