Beyond the joint: subclinical atherosclerosis in patients with psoriatic arthritis

Abstract

Background. Atherosclerosis represents a major cardiovascular risk factor and is associated with increased morbidity and mortality in patients with psoriatic arthritis (PsA). Atherosclerosis may be induced by chronic inflammation, both directly through endothelial dysfunction and indirectly through lipid oxidation, dyslipidemia, and insulin resistance. Objectives. To investigate subclinical atherosclerosis in patients with PsA and its correlation with disease activity and severity. Materials and methods. The study included 60 consecutive patients with PsA and 60 age- and sex-matched healthy controls. Subclinical atherosclerosis was evaluated using flow-mediated dilatation (FMD) of the brachial artery and carotid intima-media thickness (CIMT). Disease activity was assessed using the disease activity in psoriatic arthritis (DAPSA) score, and quality of life was evaluated using the psoriatic arthritis quality of life (PsAQoL) questionnaire. Results. CIMT and FMD were significantly different between PsA patients and controls (P < 0.001). Significant correlations were found between CIMT, FMD, disease duration, DAPSA score, and atherosclerotic cardiovascular disease (ASCVD) risk score. The ASCVD risk score was the most significant predictor of CIMT, whereas DAPSA score and disease duration were the strongest predictors of FMD. The sensitivity and specificity of FMD were 63.33% and 65.0%, respectively, while those of CIMT were 61.7% and 68.33%, respectively. Conclusions. Both CIMT and FMD are potential tools for the early identification of subclinical atherosclerosis in patients with PsA.