Higher Inflammation Burden in Psoriatic Arthritis Patients Linked to More Severe Cardiovascular Problems

Cardiovascular risk related to severity of inflammation, but not associated with disease duration.

A recent study finds a direct relationship between the severity of inflammation in psoriatic arthritis (PsA) patients and an increased risk of cardiovascular issues.

Published on May 14, 2014, in the Annals of Rheumatic Diseases, the study examines the association between the length and severity of joint inflammation with the extent of atherosclerosis in PsA patients. As the main cause of cardiovascular diseases, atherosclerosis causes immune mechanisms to interact with metabolic risk factors, allowing for lesions to form on vascular walls, the study notes.

Examining a cohort of patients with PsA who did not have other traditional cardiovascular risk factors, researchers found that patients with psoriasis are up to twice as likely to develop myocardial infarction as people unaffected by the disease.

“The increased cardiovascular morbidity in psoriatic disease may be partially attributed to the high prevalence of metabolic abnormalities, such as impaired glucose tolerance and atherogenic lipid profile, in these patients,” the study authors wrote. “However, the risk remains increased even after adjustment for these abnormalities, supporting the notion that psoriatic disease is an independent risk factor for cardiovascular events.”

The study analyzed 235 patients with PsA, with about half (44.3%) of the subjects within the first 2 years of initial diagnosis and the remaining patients having established disease at the time of their first visit. Patients with more severe atherosclerosis tended to be older men with a high body mass index, and were more likely to have diabetes, hypertension, or dyslipidemia.

A combination of joint inflammation, higher C-reactive protein levels, and increased PsA disease activity was found to correlate with more severe atherosclerosis.

While the duration of the disease was not found to be associated with severe atherosclerosis, the researchers did find that an elevated erythrocyte sedimentation rate and a higher white blood cell count is associated with more severe atherosclerosis over time. C-reactive protein, which is associated with an increased risk of cardiovascular problems, was not found to be associated with more severe atherosclerosis.

The researchers expressed surprise at the lack of association between disease duration and atherosclerosis, as prior studies of patients with rheumatoid arthritis and lupus found a link between higher cardiovascular risk and disease duration.

“Our results may be explained by the insidious onset of the disease in many patients with PsA, which makes it difficult to determine the exact date of onset,” the authors write. “An alternative explanation may be that the increase in cardiovascular risk is related, partially, to the high prevalence of traditional cardiovascular risk factors that may be present before the onset of PsA.”

Researchers note that future studies are required to determine if progression of atherosclerotic plaques can be prevented through control of inflammation by systemic therapies to reduce the risk of cardiovascular events.

“Overall, these data and our findings indicate that the extent of inflammation over time can explain part of the atherosclerotic process in patients with PsA,” the authors wrote. “These biomarkers may serve to identify patients who are at higher risk of worse disease outcome and cardiovascular events.”