Background Psoriatic arthritis (PsA) is a disease associated with an increased cardiovascular (CV) risk, due to early atherosclerosis, which is comparable to a rheumatoid arthritis population. However, there is a lack of studies that evaluate the progression of subclinical atherosclerosis over a year in these patients.
Objectives To explore the progression of the vascular damage by different techniques in patients with PsA and the factors related with these changes.
Methods Pre-post study with analytical components. 44 patients with PsA (CASPAR criteria) and peripheral joint involvement of more than one year since diagnosis were consecutively included. We gathered demographic (age, gender, BMI), clinical (traditional CV risk factors, previous CV event), and analytical variables (atherogenic index [AI], GFR [MDRD], fibrinogen, glycated hemoglobin, CRP, ESR, ultrasensitive CRP, apoB/apoA1 ratio) and basal CV risk was estimated with SCORE tool. Other variables were collected retrospectively from patients electronic medical record. The extracranial branches of carotid artery were explored by ultrasonography (US) using an Esaote MyLab70XVG with a 7–12 MHz linear transducer and an automated program measuring intima-media thickness (IMT) through radiofrequency (RFQIMT), and the presence of atheroma plaques, as per the Mannheim consensus, was registered. Pulse wave velocity (PWV) was determined, as an arterial stiffness marker, by a validated MobilOGraph® device. Patients were followed during a 2-year period between may 2014 until december 2016. All of the tests were repeated after 2 years. Statistical analysis was performed using SPSS 17.0 software.
Results We analyzed 38 patients, excluding those with high CV risk (previous CV event, GFR<60mg/dl, and/or type II or type I diabetes with organ affection) and followed during 2 years. At baseline, the mean and median of age was 59,2 and 60,5 years (39–88), respectively, mostly women (65,8%). The median BMI was 28 (17–35). 28,9% were smokers and 36,8% had hypertension. 26,3% received glucocorticoids, 57,9% NSAIDs, 84,2% DMARDs and 31,6% biologic therapies. The median CRP, ESR and DAS 28 were 5mg/L (1–19,1), 7mm/h (2–28) and 2,17 (1,24–3,7), respectively. The median SCORE was 1 (0–7), the PWV was 8 m/s (5,6–13,5) and basal IMT was 728 μ(462–1087); the presence of atheroma plaques was detected in 35,1% of the patients.
After 2 years, plaque appearance was seen in 15% more of patients, as well as worsening of PWV and IMT in 56,8% and 38,9% of patients, respectively.These changes were not significant. No patient developed a CV event.
In the bivariate analysis, PWV progression at 2 years related with advanced age (p<0,002), and with elevated SCORE (p<0,044), and showed a tendency with higher arterial systolic pressure (ASP). We also observed a tendency to an association between plaque appearance, age and ASP; as well as lower apolipoprotein A1 levels with IMT.
Conclusions The progression over time of the vascular damage in patients with PsA relates with traditional CV risk factors. These preliminary results must be confirmed in a posterior analysis with a greater number of patients.
Disclosure of Interest None declared