Background/Purpose:   Patients with psoriasis (PsO) and psoriatic arthritis (PsA) have an increased prevalence of cardiovascular (CV) risk factors, metabolic syndrome (Metsy), and higher risk for subsequent major CV adverse events¹. PsA patients have more severe subclinical atherosclerosis compared to those with PsO alone². Previous studies showed higher prevalence of coronary artery plaques in PSO, and in rheumatoid arthritis without diagnosis of coronary artery disease (CAD) compared to controls^3,4. However, no study to date has compared coronary plaque burden in PsA patients asymptomatic to CAD to controls. The objectives were 1) Study the presence, extent and type of coronary plaques as measured by coronary CT angiography (CCTA) in PsA without symptoms of CAD as compared to controls. 2) Compare plaque measurements between patients with Metsy to those without Metsy (NMetsy) and to controls. 3) Investigate the effect of disease related variables on coronary plaques.

Methods:   50 PsA patients (25 Metsy – 25 NMetsy) and 25 controls without CAD (age and sex-matched) underwent 64-slice CCTA. Plaque localisation, the number of patients with plaque and of affected coronary vessels were assessed. Plaque type was classified into calcified (CP), mixed (MP) and non-calcified plaque (NCP)⁵. Plaque volume was measured for each plaque type and was added to give a total volume (PV) in mm³. The number of segments with plaque per patient (segment involvement score (SIS 0-15)) and segment stenosis score (SSS 0-60) were calculated. Kruskal-Wallis test, rank correlations and linear regression analyses were used to study the effect of Metsy and PsA related variables on coronary plaques.

Results:   Mean age of PsA patients and controls was 58(±8.3) and 57(±5.6) years, the 2 groups were comparable for CV risk factors. 78% of PsA vs 44% of controls had plaques (P=0.007) and the number of patients with affected coronary vessels were higher in PsA (P=0.015). Mean PV, SIS and SSS were higher in PsA (P=0.002, P=0.032, P=0.004; respectively). There were more PsA patients with MP and MP volume was higher compared to controls (P=0.006). Plaque measurements in PsA patients with or without Metsy were similar. Plaque presence, PV and SSS were significantly higher in both Metsy and NMetsy patients compared to controls. Max CRP during the disease correlated significantly with PV, SIS and SSS in PsA. Disease duration, max TJC and max CRP had significant effect on the number of affected coronary vessels (P=0.034, P=0.049, P=0.022, respectively). Linear regression analyses revealed no significant relationship between PV and Metsy, whilst diagnosis of PsA (B=0.324 (CI95% 0.05-0.597) P=0.021) and max CRP (B=0.01 (CI95% 0.004-0.019) P=0.006) were independent predictors of PV.

Conclusion:   This pilot study is the first to assess coronary plaques in PsA using CCTA. PsA patients asymptomatic for CAD had a higher presence and extent of plaques, particularly MP, compared to controls. Our results suggest that PsA may result in accelerated coronary plaque formation independent of metabolic disease. References:

1. Haroon M. JRheumatol 2014
2. Eder L. ARD 2013
3. Ludwig R. Br JDermatol 2007
4. Karpouzas G. ARD 2014
5. Pflederer T. Atherosclerosis 2010

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/higher-frequency-and-severity-of-coronary-plaques-on-coronary-ct-angiography-in-psoriatic-arthritis-patients-without-symptoms-of-coronary-artery-disease-compared-to-controls/