Background/Purpose: SCORE tables
underestimate the Cardiovascular Risk (CVR) for patients with Rheumatoid Arthritis
(RA) and EULAR recommends multiplying by 1.5 the CVR obtained from
them in RA patients. A concern exists that CVR in Psoriatic Arthritis (PsA)
might be underestimated. Several studies show that the carotid intima-media
thickness (CIMT) and the presence of cholesterol plaques (CP) detected with
Ultrasound (US) are significantly associated with CVR. Our objectives were to
assess the CVR profile in PsA patients using the SCORE/European recommendations
and to study the presence of subclinical CV disease by US techniques. Methods:
Ongoing transversal descriptive study of PsA patients from a Rheumatology Unit. Variables: Age,
gender, psoriasis and PsA duration, PsA type and therapy; classic CVR factors
(BMI, hypertension, dyslipidaemia, smoking, diabetes); prevalent personal and
familiar CV events (coronary, cerebrovascular and thromboembolic events, sudden
death). The probability of fatal atherosclerotic CV events over a 10 year
period was calculated (Spanish SCORE chart/European recommendations). Then all
patients underwent bilateral US carotid study (GE LOGIQ S7 Expert US
Equipment). The common CIMT (average and maximum) measured in both common
carotids using an automatized lecture of the distal intima-media wall in a
surface of 1.39 cm or 300 points, 1 cm caudal to the carotid bulb. Plaques
defined according to the Mannheim consensus. Statistical analysis: Descriptive,
univariate (t-Test and Chi2) and  multivariate analyses (ANOVA) were performed.
Results: 72 PsA patients were included: mean age 57±11.2 years
(53% male). 3 patients had a prevalent CV event. Clinical characteristics
summarized in Table 1. Risk levels before/after the US study summarized in table 2. In the US
study, 25 patients had pathological IMT thickness or atheroma plaques (35.21%),
The
final CVR was upgraded due to the US in 23 patients (31.9%). Patients with
peripheral PsA had significantly higher CIMT than the other forms of PsA (p=0.03).
None of the other variables were associated with CIMT nor with the presence of
plaques. A positive association between HBP and CIMT was found (p=0.001, CI 95%
-0.19,-0.05) on multivariate analyses. The 3 patients with CV events had
significantly higher CIMT (p=0.08, CI 95%= -0.31, -0.09) and all had plaques
(p=0.04). Conclusion: In this sample, a substantial proportion of patients with PsA are at a very
high risk of a fatal CV event. The SCORE/European classification seems to underestimate
the CV risk, as 31.9% of the patients were upgraded to a higher risk after the
US study.

Table 1. 

Table
2.