Subclinical Atherosclerosis Seen in Patients With Psoriatic Arthritis

A recent review of biomarkers of subclinical atherosclerosis in patients with psoriatic arthritis (PsA) showed more severe atherosclerotic disease compared with patients who have only psoriasis.

PsA is a chronic immune-mediated disease; one-third of patients with skin and/or nail psoriasis will develop an inflammatory arthritis, leading to severe physical limitations and disability.

In patients with PsA some molecules may be considered as markers of atherosclerotic disease, and their detection may be a prognostic marker for the development of atherosclerotic disease. In addition to imaging procedures, these could be suitable for the management of patients with PsA.

Researchers performed a search in electronic databases (PubMed, Web of Science, Scopus, and Embase) up until July 2017. Studies were considered if they included data on biomarkers of subclinical atherosclerosis in PsA, and each article was then reviewed for quality and clinical relevance. The initial search produced 532 abstracts; that was reduced to 54 articles.

Compared with those who have only psoriasis, patients with PsA have a high prevalence of extra-articular manifestations and comorbidities, including increased risk of cardiovascular disease, endothelial dysfunction, a higher prevalence of metabolic syndrome (MetS), hypertension, hyperlipidemia, obesity, and diabetes. An additional vascular risk factor is hyperhomocysteinemia.

Patients with PsA may have increased fibrinogen, a major predictor of stroke and myocardial infarction, and C-reactive protein levels. Moreover, a higher incidence of arterial thrombosis is related to platelet hyperreactivity, so the inflammation influences platelet reactivity. The achievement of minimal disease activity may normalize platelet hyperreactivity, thus reducing thrombotic events.

Cardiovascular disease is the major cause of morbidity and mortality among patients with PsA, in particular heart attacks and stroke. One study showed that PsA is directly related to composite myocardial infarction, stroke, or cardiovascular death, with a rate ratio of 1.79 (95% CI, 1.31—2.45).

The evolution of atherosclerosis in psoriatic disease was described by 1 researcher with the term “psoriatic march.” Chronic systemic inflammation in PsA leads to insulin resistance, with endothelial dysfunction and atherosclerosis.

The researchers said the increase in cardiovascular risk in patients with PsA compared with both healthy populations and those matched for vascular risk factors showed that systemic inflammation is an independent cardiovascular risk factor. They said this hypothesis is supported by the improvement in the cardiovascular risk profile following the control of systemic inflammation with anti-inflammatory treatments.

The researchers said more cooperation is needed among specialists and primary care doctors to improve cardiovascular prevention strategies.

Reference

Peluso R, Caso F, Tasso M, et al. Biomarkers of subclinical atherosclerosis in patients with psoriatic arthritis [published online June 28, 2019]. Open Access Rheumatol. doi:10.2147/OARRR.S206931.