Background/Purpose:

Psoriatic Arthritis (PsA) is linked to both obesity and an increased cardiovascular risk.  However, the relationship between PsA disease activity and lipids, a major cardiovascular risk factor, has not been well studied.  We assessed the relationship between PsA disease activity and lipid profiles in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry.

Methods:

We performed a cross-sectional analysis of all CORRONA participants followed from 6/2008 to 10/2012 with complete data for lipids and disease activity. Longitudinal subanalysis of PsA patients with paired lipid measurements on stable statin doses was also performed.   Moderate to high disease activity was defined as CDAI>10 and/or presence of enthesitis/dactylitis. Abnormal lipids were defined as: total cholesterol (TC)>200 mg/dl (5.17 mmol/L), High Density Lipoprotein (HDL)<40 mg/dl (1.0 mmol/L, men), HDL<50 mg/dl (1.3 mmol/L, women), Low Density Lipoprotein (LDL)>100 mg/dl (2.59 mmol/L), Triglycerides (TG)>150 mg/dl (1.7 mmol/L), and atherogenic ratio (TC/HDL) >5. Models were adjusted for gender, duration of PsA, mHAQ, disease-related medication use, smoking, body mass index (BMI), diabetes (DM), use of cholesterol lowering medications and fish oil.

Results:

Of 5713 PsA patients, 725 had complete data for lipids and disease activity. 284/725 (39%) had moderate to high disease activity. Compared to the low disease activity group, the moderate to high disease activity group had more women (57% vs 46%, p=0.006) and smokers (12.7% vs 7.7%, p=0.029), and had shorter disease duration (mean 8.7 vs 11.2 years, p=0.001). Moderate to high disease activity patients were more likely to be prescribed prednisone (13% vs 4.5%, p<0.001) and non-biologic DMARDs (63% vs 51%, p=0.002), but were less likely to be prescribed anti-TNFs (57% vs 66%, p=0.015). Mean BMI in the moderate to high and low groups were 31.7kg/m2 and 30.6kg/m2, respectively, p=0.02. There were no differences between age, rate of DM, frequency of cholesterol lowering medications, and fish oil use.

Moderate to high disease activity was associated with higher odds of TC>200 mg/dl, OR 1.6 (1.1, 2.2 95%CI), p=0.01, and higher odds of TG>150 mg/dl, OR 1.6 (1.2, 2.3 95% CI), p=<0.01. Enthesitis/dactylitis was positively associated with TC>200 mg/dl, OR 1.6 (1.1, 2.5), p=0.02. There was no significant association found between disease activity and other lipid measures in the moderate to high disease vs low disease groups.

In the longitudinal analysis of 54 PsA patients with paired lipid measurements, higher PsA activity was associated with higher TG levels (β 3.85, p=0.02) and lower HDL levels (β -0.62, p<0.01) adjusted for duration between visits.

Conclusion:

Moderate to high disease activity in PsA is associated with increased levels of TC and TG.  Increasing disease activity is associated with increasing TG and decreasing HDL. This pattern of dyslipidemia in PsA is similar to the pattern observed in obesity.  Our findings suggest a commonality between PsA disease mechanisms and lipid metabolism providing a possible link between obesity, PsA and cardiovascular disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/higher-disease-activity-in-psoriatic-arthritis-is-associated-with-elevated-total-cholesterol-and-triglycerides/