Cardiovascular and other comorbidities in patients with psoriatic arthritis: A comparison with patients with psoriasis

Abstract

Objective. To determine whether the presence of psoriatic arthritis (PsA) is associated with greater comorbidity, in particular cardiovascular morbidity, compared to psoriasis without arthritis. Methods. Six hundred eleven patients with PsA were recruited from the University of Toronto Psoriatic Arthritis Clinic and 449 psoriasis without arthritis patients were recruited from the University of Toronto Psoriasis Cohort. The clinical database was used to identify the prevalence of cardiovascular and other comorbidities in both PsA and psoriasis without arthritis patients. Univariate and multivariate logistic regression analyses were conducted to estimate odds ratios (ORs), comparing the odds of ever having a given comorbid disease in PsA patients with those in psoriasis without arthritis patients. Covariates included age, sex, education, smoking status, severity and duration of psoriasis, medication status, and other comorbidities. Results. The prevalence of hypertension, obesity, hyperlipidemia, type 2 diabetes mellitus, and at least 1 cardiovascular event in PsA patients was 37.1%, 30.0%, 20.7%, 12.0%, and 8.2%, respectively. This was significantly higher than in psoriasis without arthritis patients, with unadjusted ORs ranging from 1.54 to 2.59. In the multivariate analyses, hypertension remained significantly elevated (adjusted OR 2.17). PsA was also significantly associated with infections not treated with antibiotics (presumably viral), neurologic conditions, gastrointestinal disorders, and liver disease (adjusted ORs 2.83, 4.76, 21.53, and 7.74, respectively). Infections treated with antibiotics and depression/anxiety were relatively common in PsA, with a prevalence of 30.5% and 20.7%, respectively. However, this was not significantly different from psoriasis without arthritis after multivariate adjustments. Conclusion. The results suggest that inflammatory joint disease may play a role in both cardiovascular and noncardiovascular morbidity in PsA.

Psoriatic Arthritis and Burden of Disease: Patient Perspectives from the Population-Based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey

“…This finding is consistent with prior reports of a higher prevalence of cardiovascular disease and associated risk factors, such as diabetes and other chronic diseases, in patients with PsA compared with psoriasis patients or matched controls in the community [4,6,11,15]. The multiple co-morbidities, often present in a single patient, complicate the selection of therapeutic agents due to safety concerns and create challenges in the assessment of the functional impact of PsA.…”

“…Likewise, PsA is associated with increased medical costs and loss of work productivity as the level of severity increases [4]. In addition, evidence suggests that persistent systemic inflammation fosters and worsens the severity of other co-morbidities, such as obesity and heart disease [4,6,11,15].…”

Validation of the Psoriasis Symptom Inventory (PSI), a patient-reported outcome measure to assess psoriasis symptom severity

“…Known-groups validity was assessed using baseline DLQI score categories (total scores of 2-10, 11-20, or 21-30); mean PSI item scores and standard deviations (SDs) were calculated for each DLQI category, and one-way analysis of variance was used to compare groups. Ability to detect change was examined using PtGA as anchor; mean PSI total scores and SDs were calculated for patients with PtGA worsening by ‡1 point, no change in PtGA, or improvement in PtGA by ‡1 point, and the F test using repeated measures analysis of covariance (adjusted for body mass index, age, gender, and disease duration) (14) was used to compare groups. Exploratory factor analyses were conducted to examine the measurement model.…”

“…One-week test-retest reliability was assessed using intraclass correlation coefficient (ICC) on the weekly average PSI item scores of Week 1 (mean of days 1-7) and Week 2 (mean of days [8][9][10][11][12][13][14]. The retest population was defined as patients whose psoriasis and treatment remained stable during the study period (Overall change item = "No Change" and Change in psoriasis treatment = "No").…”

Clinical and anamnestic criteria of the progression of psoriasis

“…У больных ПсА распространенность артериаль-ной гипертензии, гиперлипидемии, сахарного диа-бета 2-го типа, сердечно-сосудистых, неврологиче-ских заболеваний, желудочно-кишечных рас-стройств и болезней печени значительно выше в сравнении с группой больных ПС [39].…”