Background/Purpose: Psoriatic arthritis (PsA) is associated with increased cardiovascular risk (CV)[i]. Several studies associate low levels of 25-hydroxivitamin D (25OHD) with a greater prevalence of CV risk[ii]. Carotid ultrasound is a useful method to detect subclinical CV disease[iii]. To estimate CV risk and contrast it to presence of subclinical atherosclerosis in patients with PsA. To determine the relation between 25OHD deficit and presence of subclinical vascular damage.

Methods: Cross-sectional study included patients with PsA and peripheral joint affection of over one year evolution meeting CASPAR criteria. Demographic (sex, age, IMT), clinical (classic CV risk factors, previous CV incidents) and analytical data (liver and kidney function, calcium, phosphorus, 25OHD and PTH, total cholesterol and HDL) were recorded. CV risk was estimated with SCORE stratification table for low risk countries such as Spain. Ultrasound study was performed with Esaote MyLab xv70, 7-12 mHz linear transducer. An automated program assessed the IMT through radiofrequency (Quality intima media thickness in real time [QIMT]). Measurements were taken at the bilateral common carotid artery, and presence of atheroma plaque in the extra-cranial carotid artery was recorded following the Manheim consensus. Statistical analysis done with SPSS 17.0 program.

Results: 90 patients comprised the study, 24 of which were excluded due to high CV risk (prior CV event, glomerular filtration rate <60mg/dL, and/or Type I or II diabetes with target organ injury). Mean age was 53±11 years and most patients were women (58%), 30% were smokers, 29% were obese (mean BMI: 27±5). Mean DAS28 was 2.3±0.8 and mean HAQ was 0.5±0.7. Mean 25OHD levels were 27.56±12.8ng/dl, and PTH 54±23pg/ml. 61% of patients had vitamin D insufficiency (<30ng/ml) and 30.3% deficiency (<20ng/ml). 42%(28) of patients had low CVR estimated by SCORE (0), 49%(32) medium risk (SCORE ≥1 y<5), and 1.5% (1) high or very high risk (SCORE≥5). Mean IMT was 0.71±0.14mm and 9% exhibited IMT>0,9mm. Atheroma plaque was found in 34%. 34% of patients exhibited a pathological ultrasound (plaque and/or pathological IMT). We didn’t observe any association between DAS28 or HAQ and pathologic findings in carotid evaluation. Based on these results, 25% of patients with Low and 45% of patients with Medium SCORE should be reclassified as High Risk.

No association was observed between 25OHD levels or densitometric findings and DAS28, HAQ, presence of atheroma plaque or IMT. 

Conclusion: We proved that SCORE underestimated CV risk in patients with PsA and that carotid ultrasound allows to re-stratify such risk. Patients with atheroma plaque or pathological IMT do not show lower levels of 25OHD than those without these vascular changes.