Background/Purpose: Patients with psoriatic arthritis (PsA) are at increased risk of cardiovascular (CV) morbidity compared with the general population, probably as a result of chronic inflammation interacting with traditional CV risk factors. Two  cross-sectional studies (n<30) had reported increased arterial stiffness in patients with PsA. However, these studies were unable to assess the effect of inflammation over time. In this study, we examined whether the cumulative inflammatory burden over time is associated with an increase in arterial stiffness in a prospective cohort of PsA patients.

Methods: 72 PsA patients were followed up for 6.6±0.17 years. Clinical and cardiovascular risk factors were assessed at baseline and last visit. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured at each clinic visit. Cumulative inflammatory burden was represented by the cumulative averages of repeated measures of ESR and CRP, which were calculated from the area under the curve divided by the follow up time. Arterial stiffness was measured at the last visit as brachial-ankle pulse wave velocity (PWV) by a dedicated tonometry system (Non-Invasive Vascular Profile Device VP-2000; Omron Healthcare, Bannockburn, Illinois, USA). The correlation among PWV and cumulative averages of ESR (ca-ESR) and CRP (ca-CRP), as well as baseline and last follow up clinical parameters and CV risk factors were explored.

Results: The median PWV at last follow up was 1463 (interquartile range: 1331-1676) cm/s. There was a significant correlation between PWV and ca-ESR (Spearman’s rho: 0.390, p =0.001). PsA patients were divided into 2 groups based on whether their PWV value is ≥ (High PWV group) or <1463 cm/s (Low PWV group). The High PWV group had a significantly higher ca-ESR compared with the Low PWV group [29 (19-44) vs. 18 (10-32) mm/1^st hr, p =0.005], There was also a trend suggestive of an increased ca-CRP in the High PWV group (p =0.087). The High PWV group were older, had a longer disease duration and a higher prevalence of having Framingham 10-year CV risk score (FRS) of > 10% at baseline. The High PWV group also had a lower body mass index (BMI), higher systolic blood pressure (SBP) and damage joint count at PWV assessment. In the regression analysis, high ca-ESR (defined as ≥75^th percentile: 37 mm/1^st hr) was associated with a higher likelihood of being in the High PWV group [OR: 5.969 (95% confidence interval: 1.361-26.176), p =0.018, adjusted for baseline clinical parameters and CV risk factors; and 5.140 (1.162-22.734), p=0.031, adjusted for last visit parameters, respectively].

Conclusion: Cumulative inflammatory burden was associated with increased arterial stiffness in patients with PsA even after adjustment for CV risk factors, emphasizing the important role of chronic inflammation in accelerating the development of CV risks in PsA patients.

Table 1. Clinical features at baseline and last follow up in patients with high and low PWV group

	Baseline				Last follow up
	Low PWV	High PWV	p value		Low PWV	High PWV	p value
Male gender	18 (50.0%)	18 (50.0%)	1.000
Age (years)	43.6±10.0	55.6±10.1	<0.001
PsA duration (years)	7.5±6.8	11.0±7.5	0.041
BMI (kg/m2)	25.7±4.0	24.6±3.3	0.184		25.7±3.6	23.9±3.1	0.028
Systolic BP	133±23	139±21	0.226		122±13	132±16	0.003
Framingham 10-year CVD risk > 10%	13 (39.4%)	23 (67.6%)	0.020		2 (5.6%)	8 (22.2%)	0.085
Damaged joint count	1 (0-3)	2 (0-6)	0.112		1 (0-4)	4 (1-8)	0.011

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cumulative-inflammatory-burden-is-independently-associated-with-increased-arterial-stiffness-in-patients-with-psoriatic-arthritis/