More CV Risk Factors Associated With Greater Disease Burden in Psoriatic Arthritis

Cardiometabolic comorbidities are a considerable burden in patients with psoriatic arthritis (PsA), and patients who had a higher number of cardiovascular (CV) risk factors had greater disease activity, according to a study in Medicina.

The researchers noted that PsA is associated with an elevated risk of CV disease and events, but most previous studies of CV disease in PsA have been focused on “how inflammation affects subclinical CV disease or CV events. However, the way in which CV risk factors correlate with disease related data in PsA has not been extensively explored,” they wrote.

The cross-sectional study included 305 patients with PsA and 179 controls. The patients with PsA had a median disease duration of 6 years, and none of the patients had established CV disease. Surveys to assess CV risk factors and medication were performed for the patients with PsA. The patients were also evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Disease Activity Index for Psoriatic Arthritis (DAPSA).

The authors reported that 27% of the patients did not have CV risk factors, but more than half (52%) had the presence of 1 or 2 CV risk factors and 21% had the presence of 3 or more CV risk factors. Most of the patients with PsA were considered to be in clinical remission based on the DAPSA score (median, 3.8). Only 10% of patients had a BASDAI score of 4 or higher.

Using a multivariable multinomial regression analysis with non-CV risk factors as the reference variable, the researchers found disease duration was positively and independently associated with a higher odds ratio (OR) of having 1 to 2 CV risk factors (OR, 1.06; 95% CI, 1.04–1.08; P = .000), and 3 or more CV risk factors (OR, 1.12; 95% CI, 1.09–1.16; P = .000). The DAPSA score was also positively associated with a higher number of CV risk factors. Patients with low and moderate or high DAPSA scores had significant odds for 1 to 2 CV risk factors compared with patients who were considered to be in remission.

The authors noted that they “could not establish the actual impact on each individual CV risk factor on disease activity,” which they considered a limitation of the study. In addition, because they did not assess quantity of previous disease-modifying antirheumatic drugs or anti–tumor necrosis factor-alpha treatments, they could not determine whether there was an association between the amount of previous treatments and the number of CV risk factors.

“Increasing awareness of the influence of CV risk factors in PsA, not only on the CV disease, but also on disease activity appears to be of major relevance,” the authors concluded.

Reference

Ferraz-Amaro, Prieto-Peña D, Palmou-Fontana N, et al. The number of traditional cardiovascular risk factors is independently correlated with disease activity in patients with psoriatic arthritis. Medicina (Kaunas). 2020;56(8):e415. doi:10.3390/medicina56080415