Background Multiple studies suggest that patients with Psoriatic Arthritis (PsA) are at increased risk of cardiovascular diseases than the general population. This risk seems to be strongly associated with subclinical atherosclerosis and high prevalence of comorbidities.
Objectives To assess the prevalence of comorbidities in patients with PsA and their impact on patients' 10-year cardiovascular risk and quality of life (QoL)
Methods A cohort of 280 PsA patients has been followed prospectively between January 2009 and December 2013. Clinical, laboratory and quality of life data were collected every six months. The frequency of 25 comorbidities was ascertained. Paired t-test was conducted to compare variables at the baseline and 24 months. Regression analyses were performed to estimate the magnitude of the association between number and type of comorbidities and variables of interest. Ten-year CV risk was assessed using the Framingham Risk Score and 2009 Canadian Cardiovascular Society guidelines; SF-36 and EQ-5D forms were used for patients' quality QoL.
Results A total of 200 patients (50.5% males) were included in this analysis with mean (SD) age 50.2 (10.5) and mean (SD) of PsA duration 4.4 (5.8) years. Prevalence of comorbidity was high with 58% of patients having 4 or more of coexisting conditions. The most prevalent were Obesity (60.5%), non-PSA musculoskeletal diseases (59.5%), HTN (27.5%), Anxiety/Depression (23.5%), DM (15%) and IHD (14.5%). Polyarthritis was the most common pattern (57%), followed by DIP (50%), olygoarthritis, axial, and both axial and peripheral joints involvement. Ten-year CV risk was associated with patients' age at PsA diagnosis (p<0.001; 95%CI 0.29-0.57), duration of PsA (p<0.001; 95%CI 0.27-0.45), and traditional CV comorbidities such as dyslipidemia (p<0.001), hypertension (p=0.019), diabetes (p<0.001), CHD (p=0.015), cerebrovascular disease (p0.003), smoking (p=0.011), and peripheral vascular disease (p<0.001). Other comorbidities in the model failed to achieve significant association. In 24 months, the 10-year risk for CV event improved non-significantly. Disease activity improved significantly (CRP (p<0.001), ESR (p=0.030), DAS28 (p<0.001). Also improvement was evident in the PASQ (p<0.001) and PASI (p<0.001)) scores. Treatment of 31.5% of patients with statins reduced the values of TC, LDL-C and Atherogenic Index (p=0.050, p=0.019 & p<0.001). General Health (GH) and its Physical (PCS) and Mental (MCS) component scores of the SF-36 were significantly and negatively associated with axial involvement, polyarthritis, and axial with peripheral joints involvement. Those three parameters of QoL were also significantly affected by Anxiety/Depression (p=0.002, p=0.012 & p<0.001), Obesity (p=0.012, p=0.023 & p=0.030), and total number of comorbidities (p=0.008, p=0.033 & p=0.035). EQ-5D VAS (p=0.007) and PCS (p=0.001) improved in 24 months without significant changes in patients' MCS and GH.
Conclusions There was a high prevalence of cardiovascular comorbidities with their significant impact on patients' 10-year prognosis for CV event. The effect of comorbidity on patient self-reported general health and its physical and mental components was related to both the type of comorbidity and number of comorbidities. Spinal and polyarticular joint involvements were significantly associated with worsened patients' quality of life.
Disclosure of Interest None declared