Review: Patients With Psoriatic Arthritis Have Increased Rates of Metabolic Syndrome

The prevalence of metabolic syndrome (MetS) is significantly increased among patients with psoriatic arthritis (PsA) compared with rates among those with psoriasis (PsO) or rheumatoid arthritis (RA), according a systematic review and meta-analysis published in the International Journal of Rheumatic Diseases.

MetS is defined as a cluster of metabolic abnormalities, including hypertension, obesity, insulin resistance, and other conditions, in which individuals also exhibit higher levels of baseline inflammation.

PsA, PsO, and RA are all associated with systemic inflammation and increased cardiovascular morbidity and mortality. In addition, “previous studies have demonstrated that MetS and obesity are poor prognostic indicators in the minimal disease activity (MDA) state in patients with PsA, despite recent advancements in disease-modifying antirheumatic drugs therapy,” the authors wrote.

To determine whether patients with PsA exhibited increased rates of MetS compared with other populations, the researchers searched MEDLINE, PubMed, EMBASE, Google Scholar, ProQuest, Ebsco CINAHL, Scopus, ScienceDirect, Web of Science, and the Cochrane Libra for all relevant studies published between January 1990 and August 2019.

Any study with 20 or fewer patients was excluded from the final analysis, which included 24, 89, and 53 studies for PsA, PsO, and RA, respectively.

Although a high degree of heterogeneity was present, random-effects model analyses revealed:

• The pooled mean (SD) prevalence of MetS in PsA populations was 0.46 (0.06) 5% CI, 0.40-0.51)
• The prevalence of MetS in PsO and RA populations was 0.34 (0.03) (95% CI, 0.32-0.37) and 0.31 (0.04) (95% CI, 0.27-0.35), respectively
• Patients with PsA were 1.62 (0.036) (95% CI, 1.50-1.74) and 1.66 (0.038) (95% CI, 1.54-1.79) times more likely to have MetS compared with PsO and RA populations
• Percentages of patients with PsA and MetS in the Europe, Asian, North American, and Middle Eastern groups were 47.2%, 45.78%, 34.88% and 48.4%, respectively
• In PsA populations, patients from countries with a lower gross national income (GNI) tended to have a higher prevalence of MetS
• The prevalence of PsA was also higher when matched to RA and PsO populations from matched GNI groups

The researchers found it difficult to determine how many patients with PsO also had PsA, marking a limitation to the review. Furthermore, some data relating to the prevalence of different MetS criteria were not available.

“MetS is often not assessed for by rheumatologists as part of routine assessments in patients with inflammatory arthritis,” the authors wrote. Because different metabolic risk factors can affect the efficacy of disease-modifying therapy, this finding should be addressed through stringent cardiovascular risk assessment and stratification in patients with PsA.

Future research should focus on utilizing standardized definitions of MetS in PsA populations to determine whether MetS presence explains increased cardiovascular risk in the patients.

Research should also investigate if aggressive management of cardiovascular risk factors increases the likelihood of attaining MDA without changing pharmacological therapy, the authors concluded.

Reference

Loganathan A, Kamalaraj N, El-Haddad C, Pile K. Systematic review and meta-analysis on prevalence of metabolic syndrome in psoriatic arthritis, rheumatoid arthritis and psoriasis. Int J Rheum Dis. Published online June 2, 2021. doi:10.1111/1756-185X.14147