Carotid Intima-Media Thickness in Psoriatic Arthritis

Abstract

on behalf of the CaRRDs study group Objective-Subjects with psoriatic arthritis (PsA) have an abnormally high prevalence of vascular risk factors (VRFs) and are predisposed to vascular mortality. Tumor necrosis factor (TNF)-␣, a major determinant of inflammation, is involved in atherosclerosis. Ultrasonographic carotid intima-media thickness (C-IMT) evaluation allows for subclinical atherosclerosis detection. Methods and Results-Two hundred twenty-four PsA patients (120 on TNF-␣ blockers and 104 on traditional disease-modifying antirheumatic drugs [DMARDs]) underwent a C-IMT ultrasound assessment. As many as 305 matched subjects without any inflammatory/rheumatologic disease served as controls. The C-IMT of PsA subjects without VRFs was higher (PϽ0.0001) than that of controls, the C-IMT of PsA subjects with Ն1 VRF(s) was lower (PϽ0.0001) than that of controls, and the C-IMT was lower (PϽ0.0001) in those on TNF-␣ blockers than in those on DMARDs. Carotid plaques were detected in 15.8% of those on TNF-␣ blockers and in 40.4% of those on DMARDs (PϽ0.0001). Treatment duration inversely (␤ϭϪ0.317, PϽ0.0001) predicted C-IMT in PsA subjects on TNF-␣ blockers but not in those on DMARDs (Pϭ0.313). Conclusion-Among PsA individuals, the C-IMT is higher in subjects on DMARDs than in those on TNF-␣ blockers.

Impact of body weight on the achievement of minimal disease activity in patients with rheumatic diseases: a systematic review and meta-analysis

“…However, such an association does not entirely explain the extent of premature atherosclerosis in subjects with rheumatic diseases, and inflammation appears to act synergistically with traditional vascular risk factors (VRFs). In fact, several studies demonstrated that patients with rheumatic diseases had increased platelet reactivity [6–8], a higher grade of subclinical atherosclerosis [4, 9], impairment of endothelial function, and arterial stiffness [10–12], as compared with control subjects matched for CV risk factors. In this setting, antirheumatic treatment was demonstrated to have beneficial effects on lowering the CV risk in these patients by controlling systemic inflammation, with maximum effect in those who achieved MDA [8].…”

“…Besides articular manifestations, PsA and RA are characterized by an increased cardiovascular (CV) risk [3, 4], as represented by a higher prevalence of metabolic syndrome and of some of its major features (obesity, hypertension, hypercholesterolemia, hypertriglyceridemia, impaired fasting glucose) [5], increased platelet reactivity [6–8], higher degree of subclinical atherosclerosis [4, 9], impairment of endothelial function, and arterial stiffness [10–12]. In particular, several studies have shown a higher prevalence of obesity in patient with PsA and patients with RA than in the general population.…”

Obesity and the prediction of minimal disease activity: A prospective study in psoriatic arthritis

“…Intervention studies (10) support such formulation. On the other hand, major markers of atherosclerosis (carotid intima-media thickness and hepatic steatosis) that assess the global damage secondary to metabolic and inflammatory determinants (24) are severely affected in PsA subjects (2,13,25). These data provide the rationale for testing whether, among PsA subjects starting a treatment with TNF␣ blockers, obesity would impact achieving MDA and s-MDA.…”

“…For all enrolled subjects, exclusion criteria were the lack of informed consent signature, age Ͻ18 years, previous treatment with TNF␣ blockers, malignancy, hematologic diseases, autoimmune diseases other than PsA, unstable medical conditions, and ongoing pregnancy. After informed consent signature, data about age, sex, height, weight, disease duration, disease activity, previous and/or current treatments, and VRFs were collected from all patients as previously described (13). According to current guidelines (14), obesity was defined as a body mass index (BMI) Ͼ30 kg/m 2 .…”

Cardiovascular Disease in Inflammatory Disorders - Psoriasis and Psoriatic Arthritis

“…They were found to have thinner carotid intima-media thickness compared to those who were treated with DMARDs (Di Minno et al, 2011). With these findings, it is possible that control of chronic inflammation in these patients may have a significant role in preventing vasculopathy.…”