Prevalence and Risk Factors of Atherosclerosis in Patients with Psoriatic Arthritis

https://doi.org/10.1016/j.semarthrit.2006.09.001Get rights and content

Objectives

To evaluate the extent of subclinical atherosclerosis by measuring the intima-media wall thickness (IMT) of the common carotid artery in patients with psoriatic arthritis (PsA) and to identify vascular risk factors associated with PsA.

Methods

Forty-seven patients with PsA were compared with 100 allegedly healthy subjects. Carotid duplex scanning was used to measure common carotid artery IMT. Traditional risk factors, such as gender, age, body mass index (BMI), hypertension, smoking, and lipids were checked. Assessment of PsA activity included clinical patterns of involvement, degree of severity, duration of morning stiffness, number of tender and swollen joints, degree of pain and fatigue, the Bath Ankylosing Spondylitis Disease Activity Index, the Psoriasis Area and Severity Index, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen.

Results

The average IMT (mean ± standard deviation) for PsA patients was significantly higher compared with controls (0.76 ± 0.11 versus 0.64 ± 0.27, respectively, P < 0.00001) for the whole group and after adjustment for age, gender, BMI, hypertension, and hyperlipidemia. The PsA subjects had significantly higher levels of hypertension, hyperlipidemia, ESR, CRP, and fibrinogen, and their average IMT significantly correlated with age, BMI, duration of skin and joint disease, spine involvement, ESR, and fibrinogen. IMT did not correlate with the presence of oligo- or polyarthritis but was increased in patients with clinical spinal involvement. IMT was not associated with the degree of severity or the use of different therapies for PsA, including methotrexate or tumor necrosis factor-α-blocking agents.

Conclusions

PsA patients exhibited greater IMT than healthy controls. Increased IMT independently correlated with parameters of disease activity and conventional risk factors of atherosclerosis.

Section snippets

Patients

Patients 18 years of age or older who were diagnosed as having PsA and were being routinely treated at our medical center’s Department of Rheumatology were consecutively invited to participate in this study. All patients who agreed to be part of the study were unselectively recruited and evaluated. They all fulfilled the currently accepted criteria for psoriasis, defined as the presence of typical skin lesions confirmed by a dermatologist, and for PsA, ie, the presence of a rheumatoid

Results

Table 1 summarizes the demographic and anthropomorphic data of the entire study cohort. The gender distribution for the 2 groups was similar, but the PsA group was significantly older and had a higher mean body weight and BMI. Most of the patients had psoriasis and PsA for years and most had a polyarticular pattern of arthritis (Table 2). The laboratory findings are summarized in Table 3.

Discussion

Chronic inflammatory conditions are increasingly linked to accelerated atherosclerosis (1, 2, 3, 4, 5), but their association with PsA has not been investigated. Our findings in the present study demonstrated greater thickness of the common carotid artery in PsA patients than in healthy controls. This increased IMT correlated with several tested parameters, such as the duration of skin and joint disease, spine involvement and levels of fibrinogen, as well as with conventional risk factors of

Acknowledgment

Esther Eshkol is thanked for editorial assistance.

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