Objective We compared the prevalence and the clustering of the Metabolic Syndrome (MetS) components: obese body mass index (BMI ≥ 30 kg/m2), hypertriglyceridemia, low high-density lipids, hypertension and diabetes, in patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA) in the Consortium of Rheumatology Researchers of North America (CORRONA) registry. Methods We included CORRONA participants with the rheumatologist-confirmed clinical diagnoses of PsA and RA with complete data. We used a modified definition of MetS that did not include insulin resistance, waist circumference or blood pressure measurements. Logistic regression models were adjusted for age, sex and race. Results In the overall CORRONA population, the rates of diabetes and obesity were significantly higher in PsA compared with RA. In 294 PsA and 1162 RA participants who had lipids measured, the overall prevalence of MetS in PsA vs. RA was 27% vs. 19%. The odds ratio (OR) of MetS in PsA vs. RA was 1.44 (95% confidence interval (CI) 1.05 to 1.96), p=0.02. The prevalence of hypertriglyceridemia was higher in PsA compared with RA, 38% vs. 28%, OR 1.51 (95% CI 1.15 to 1.98), p=0.003. The prevalence of type II diabetes was also higher in PsA compared with RA (15% vs. 11%), OR 1.56 (95% CI 1.07 to 2.28), p=0.02, in the adjusted model. Similarly, higher rates of hypertriglyceridemia and diabetes were observed in the subgroup of PsA and RA patients with obese BMI. Conclusion PsA is associated with the higher rates of obesity, diabetes, and hypertriglyceridemia, compared with RA.

In order to describe the clinical and serologic features of a cutaneous vasculitis due to cocaine contaminated with the adulterant levamisole, we report four new cases of this syndrome along with 12 previously reported cases identified through a PubMed Literature search (1964 to March 2011). Of the 16 patients described, the average age was 43, with a female predominance (81% of patients). Over half of patients had involvement of the earlobes, and the rash frequently affected the extremities in a "retiform" pattern. Leukopenia or neutropenia was reported in 56% of patients. Ninety-three percent were anti-neutrophil cytoplasmic antibody positive, and 63% tested positive for anti-phospholipid antibodies. The predominant pattern seen on histopathological examination of the skin was small vessel vasculitis and/or a thrombotic vasculopathy. Treatment in these patients varied widely, with several patients showing improvement or resolution of the rash without specific therapy following cessation of illicit drug use. This new cutaneous vasculitis syndrome can be recognized by its characteristic rash and skin pathology, together with leukopenia and autoantibody production. Certain clinical features can be attributed to the adulterant levamisole, though cocaine as well may play a role in its pathogenesis.

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Background Psoriatic arthritis (PsA) is associated with a higher frequency of abnormal lipids and obesity compared with healthy controls and rheumatoid arthritis. There is also an increased risk of developing PsA in obese individuals, perhaps related to the inflammatory milieu provided by excess adiposity. It is also known that inflammatory cytokines contribute to derangements in lipid metabolism. However, the relationship between disease activity and lipid profiles in PsA is not well studied. Objectives To assess the cross-sectional relationship between PsA disease activity and lipid profiles in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. Methods We analyzed PsA patients followed in CORRONA between 6/2008 and 10/2012 with complete data for lipids and disease activity. Moderate to high disease activity was defined as CDAI>10 and/or presence of enthesitis/dactylitis. Abnormal lipids were defined as: total cholesterol (TC)>200 mg/dl (5.17 mmol/L), High Density Lipoprotein (HDL)<40 mg/dl (1.0 mmol/L, men), HDL<50 mg/dl (1.3 mmol/L, women), Low Density Lipoprotein (LDL)>100 mg/dl (2.59 mmol/L), Triglycerides (TG)>150 mg/dl (1.7 mmol/L), and atherogenic ratio (TC/HDL) >5. Models were adjusted for gender, duration of PsA, mHAQ, disease-related medication use, smoking, body mass index (BMI), diabetes (DM), use of cholesterol medications and fish oil. Results Of the 725 PsA patients included in this study, 284 (39%) had moderate to high disease activity. Compared to the low disease activity group, the moderate to high disease activity group had a higher proportion of women (57% vs 46%, p=0.006) and smokers (12.7% vs 7.7%, p=0.029), higher log ESR (2.44 vs 2.13, p=0.003) and log CRP (1.63 vs 1.31, p=0.002), and shorter disease duration (mean 8.7 vs 11.2 years, p=0.001). Those with moderate to high disease activity were more likely to be prescribed prednisone (13% vs 4.5%, p<0.001) and non-biologic DMARDs (63% vs 51%, p=0.002), but were less likely to be prescribed TNF inhibitors (57% vs 66%, p=0.015). Mean BMI in moderate to high and low groups were 31.7kg/m2 and 30.6kg/m2, respectively, p=0.02. There were no differences between age, rate of DM, frequency of cholesterol lowering medications, and fish oil supplementation. Moderate to high disease activity was associated with higher odds of TC>200 mg/dl, OR 1.6 (1.1, 2.2 95%CI), p=0.010, and higher odds of TG>150 mg/dl, OR 1.6 (1.2, 2.3 95% CI), p=0.005. Enthesitis/dactylitis was positively associated with TC>200 mg/dl, OR 1.6 (1.1, 2.5), p=0.02. There was no significant association found between disease activity and other lipid measures in the moderate to high disease vs low disease groups. Conclusions Moderate to high disease activity in PsA is associated with increased levels of total cholesterol and triglycerides, suggesting a commonality between PsA disease mechanisms and lipid metabolism that deserves further exploration. The implications of this association for cardiovascular disease in PsA need to be studied further. Di...

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