Background While Psoriatic Arthritis (PsA) is characterized by inflammation of both skin and joints there has been an increased recognition that PsA is associated with modest increase in the risk of cardiovascular diseases. Metabolic syndrome (MetSyn) is a cluster of 5 classic cardiovascular risk factors – hypertension, hypertriglyceridemia, hyperglycemia, reduced HDL cholesterol and abdominal obesity. The data is quite inconsistent as regards the prevalence of MetSyn in PsA, and to our knowledge features contributing to MetSyn including underlying patient’s characteristics, life style and severity of psoriatic disease have not been clearly established.
Objectives The objectives of our study were: 1) To investigate the prevalence of MetSy in an ethnically homogenous consecutive cohort of established PsA, 2) to identify clinical associations of MetSy in patients with PsA
Methods A consecutive cohort of 283 PsA patients attending rheumatology clinics of St Vincent’s University Hospital, Dublin was included. Following informed consent, patients underwent a detailed skin and rheumatologic assessment including disease activity measures [PASI, Body Surface Area (BSA) for Psoriasis (Ps); DAS 28 CRP], CRP, ESR, HAQ, DLQI, Bristol Rheumatoid Arthritis Fatigue Numeric Rating Scale (BRAF-NRS), EQ5D, and radiographs were obtained. Other relevant data collected included: BMI, waist and hip circumference, alcohol and smoking habits, educational status, and fasting venous blood samples for insulin, glucose, lipid profile, and HbA1c. In addition, an extensive medical record review was performed to obtain information regarding their previous psoriatic disease features. Severe psoriatic disease was defined as having one or more of the following: radiographic evidence of erosions, or osteolysis, or sacroiliitis; TNFi used for PsA or Ps; severely disabled as per HAQ score of >2–3); severe Ps (PASI and/or BSA>10).
Results A total of 283 PsA patients [mean age 55±12 years; 52% female; mean PsA duration=19±9 years] were studied. MetSyn was present in 44% of the cohort; 50% of these patients had clustering of ≥4 of these MetSyn risk factors, in particular, elevated BP (74%), elevated waist circumference (56%) and elevated triglycerides (43.5%). Mean BMI of the entire cohort was 29±5. In the whole cohort, 9.5% had known personal history of ischemic cardiovascular disease, with 67% of these patients having MetSyn (p=0.01). Insulin resistance was noted to be present in 15.6% of patients (n=263), and 83% of these had MetSyn. On univariate analysis, MetSyn patients were less educated (p=0.02), had more type-2 psoriasis (p=0.007), later Ps and PsA age of onset (p=<0.001 and 0.006, respectively), shorter time from psoriasis to arthritis development (p=0.050), higher HAQ scores (p=0.08), higher fatigue scores (p=0.056), higher EQ5D (p=0.01), high smoking pack years (p=0.056), and no association with PsA or psoriatic disease duration (p=0.20, and 0.85, respectively). No significant association was noted with duration of PsA, inflammatory markers and units of alcohol consumed. However, on multiple regression analysis, model predicted significant association with MetSy with higher smoking pack years (OR 1.03, p=0.01), and the severity of psoriatic disease (OR 8.8, p=0.004).
Conclusions Among PsA patients, MetSyn is highly prevalent, and is associated with the severity of underlying psoriatic disease.
Disclosure of Interest None Declared