(06-06-14) Psoriatic Arthritis: Systemic Burden Tied to Atherosclerosis

Lara C. Pullen, PhDMay 22, 2014
Patients who have psoriatic arthritis (PsA) and an increased burden of
inflammation are also likely to have more severe atherosclerosis.
Lihi Eder, MD, PhD, from the Centre for Prognosis Studies in the Rheumatic
Diseases, Toronto Western Hospital, Ontario, Canada, and colleagues present
their analysis of a large (n = 235) PsA cohort in an article published online
May 14 in the Annals of Rheumatic Disease. The study used atherosclerosis as a
surrogate for clinical cardiovascular events.
Patients with PsA have many of the traditional cardiovascular risk factors.
The investigators explain in their discussion that although the association
between PsA and increased cardiovascular disease has been established, few
studies have investigated the underlying cause behind the link. Atherosclerosis
is a chronic vascular inflammation, and the investigators propose that the
association between PsA and atherosclerosis is mediated by traditional
cardiovascular risk factors.
The investigators found that patients with severe atherosclerosis were more
likely to be older (P < .0001), obese (P = .01), smokers (P = .008), and have
hypertension (P = .001), diabetes (P < .0001), and dyslipidemia (P < .0001).
When the authors performed a multivariate regression model adjusted for age and
sex, higher erythrocyte sedimentation rate (P = .009), white blood cell count
(P = .015), and Disease Activity for PsA (P = .04) were all associated with
more severe atherosclerosis. In other words, patients with a higher
inflammatory burden had more evidence of atherosclerosis.
The associations were no longer significant, however, once the researchers
adjusted for traditional cardiovascular risk factors.
In addition, the investigators found no association between disease duration
and atherosclerosis. Nor did they find an association between C-reactive
protein and atherosclerosis, despite its association with increased
cardiovascular risk in the general population.
"Our paper highlights the fact that it is the burden of inflammation, not just
evidence of inflammation at one point, which is important. Generally, we adjust
for items that might have an effect on the outcome. When we adjusted for items
that are known to be related to atherosclerosis, such as features of the
metabolic syndrome, which [are] also increased among patients with PsA, the
effect of inflammatory markers was lost, suggesting that the metabolic features
may mediate the effect of inflammation," coauthor Dafna D. Gladman, MD, FRCPC,
also from Toronto Western Hospital, told Medscape Medical News.
The investigators suggest that control of inflammation and metabolic factors
via systemic therapies may prevent the progression of atherosclerotic plaques
and reduce the risk for cardiovascular events. "[The study] supports the notion
that patients with inflammatory arthritis should be treated aggressively to
control inflammation in order to prevent this comorbidity," Dr. Gladman noted.
Joseph Merola, MD, dermatologist at Brigham and Women's Hospital in Boston,
Massachusetts, partially agrees.
"This means 2 things for physicians taking care of patients: (1) appropriate
control of traditional risk factors (lipid/cholesterol management, diabetic
control, weight loss, smoking cessation), [which] remain the most important
factors to control the development of atherosclerotic disease and subsequent
cardiovascular disease; (2) exposure to the increased inflammation of psoriatic
arthritis likely contributes to the severity of disease to some degree;
however, further data and studies are needed to know whether control of this
inflammation will have any effect on preventing the formation of these plaques
and impact cardiovascular disease risk. Those patients with higher, persistent
levels of systemic inflammatory markers may be at increased risk for
cardiovascular disease," said Dr. Merola, who was not involved in the study.
The authors, Dr. Gladman, and Dr. Merola have disclosed no relevant financial
relationships.

Source: Ann Rheum Dis. Published online May 14, 2014.

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