Background/Purpose: Psoriatic arthritis (PsA) is a chronic, inflammatory, and immune-mediated disease that affects up to 30% of psoriasis (PsO) patients. Nail psoriasis affects 80% of PsA patients and 30%–50% of PsO patients. Nail involvement in PsO patients has been associated with a higher prevalence of metabolic syndrome, a higher risk of heart failure, and a higher cardiovascular risk (CVR) overall. We aimed to determine the relationship between the Nail Psoriasis Severity Index (NAPSI) and CVR assessed by eight cardiovascular risk calculators.

Methods: Cross-sectional, observational, and comparative study of patients with PsA who met the CASPAR 2006 classification criteria, aged 18 years or older. Patients with a diagnosis of overlapping syndromes, a history of major cardiovascular events, and pregnancy were excluded. The NAPSI was obtained through a physical examination. The CVR of each patient was assessed by eight different CVR algorithms, including Framingham Risk Score (FRS) lipids, FRS body mass index (FRS-BMI), American College of Cardiology and American Heart Association (ACC/AHA) Risk Algorithm, Systematic Coronary Risk Evaluation (SCORE), QRISK3, Reynolds Risk Score (RRS), Predicting Risk of Cardiovascular Disease Events (PREVENT ™) ASCVD and PREVENT ™ Heart Failure. Group distribution was assessed using the Kolmogorov-Smirnov test. The comparisons were made using the Chi-Square Test, T- Student test and Kruskal Wallis test, accordingly. The correlation was performed through Spearman’s rho. A p-value of ≤ 0.05 was considered statistically significant.

Results: A total of 71 patients with PsA were included, 31 having nail involvement and 40 without nail involvement. The group’s demographic and clinical characteristics are shown in Table 1.  Women represented the majority of our population (n=44,53.6%), with a mean age of 54.9 ± 8.9 years and a mean disease duration of 10.2 ± 8.8 years. Groups were well balanced, without statistical difference regarding sex, age and cardiovascular comorbidities (p >0.05).Patients with nail involvement had a slightly but not significantly higher score in DAPSA (20.4 ± 18.2 vs 17.8 ± 19.0, p >0.05) and PASI (1.2 (0.2-4.5) vs (0.4 (0.0-1.8), p >0.05) scores (Table 1). CVR score was higher in PsA patients with nail involvement using SCORE calculator compared to the other group ( 2.0 (1.0-3.5) vs 1.0 (0.0-2.0), p= 0.03). No difference was found using QRISK3, FRS BMI and lipids, ACC/AHA 2013 risk score, RRS, PREVENT ™ ASCVD 10-years andPREVENT ™ Heart Failure calculators (p >0.05). A significant weak positive correlation was found between NAPSI and age (Pearson’s r=0.267, p=0.012), PASI (Spearman’s rho= 0.214, p= 0.037), ACC/AHA (Spearman’s rho= 0.202, p=0.045), FRS BMI (Spearman’s rho= 0.229, p= 0.027), SCORE (Spearman’s rho=0.244, p=0.020), PREVENT ™ ASCVD 10 years (Spearman’s rho= 0.198, p= 0.049) and PREVENT ™ HF (Spearman’s rho=0.291, p=0.007).

Conclusion: In conclusion, a NAPSI ≥1 score is related to higher CVR assessed through the SCORE algorithm as well as a positive correlation with other CVR assessment tools. PsA patients with nail involvement must have close CVR screening due to their higher risk of developing CV events compared with the PsA population without nail involvement.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/relationship-between-nail-psoriasis-severity-index-napsi-and-cardiovascular-risk-assessed-by-eight-cardiovascular-risk-calculators/