Assessment of subclinical atherosclerosis in psoriatic arthritis patients without clinically overt cardiovascular disease or traditional atherosclerosis risk factors

BACKGROUND
Cardiovascular diseases (CVD) are more prevalent in almost all patients with chronic inflammatory musculoskeletal diseases compared to healthy counterparts. Herein, we aimed to assess the presence of subclinical atherosclerosis in patients with psoriatic arthritis (PsA) in comparison to patients with rheumatoid arthritis (RA) and healthy controls.

METHODS
A total of 30 patients with PsA, 30 patients with RA and 30 healthy control subjects were enrolled in this parallel group study. All demographic, clinical and laboratory data of study groups were recorded. Disease activity score (DAS)-28 was used for joint activity assessment. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured as acute phase reactants. Flow mediated dilatation (FMD) and carotid intima media thickness (CIMT) were measured in all participants.

RESULTS
Median duration of disease in patients with PsA was 60 (8-216) months. 22/30 (73.3%) PsA patients had the diagnosis of psoriasis and 13/30 (48.1%) of them had active disease. The study groups were similar in regard to age, gender and body mass index. 23 (76.7%) of PsA patients and 5 (16.7%) of RA patients were using an anti-tumor necrosis factor (TNF)-alpha therapy (p<0.001). FMD % was significantly lower in both PsA and RA patients than healthy controls (p<0.001). Median CIMT was higher in RA patients compared to PsA patients and healthy controls (p=0.008). There was no difference of FMD % and CIMT between patients with and without active joint lesion.

CONCLUSIONS
Endothelial functions were impaired in PsA like RA in the absence of conventional risk factors or overt CVD. Such a finding may show a potential association of PsA with atherosclerosis and CVD.