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The issue of vascular risk in chronic arthropathies and especially the magnitude of such risk and its clinical implications in daily practice are of considerable current importance. Similarly, the relative risk across distinct arthropathies and other chronic inflammatory conditions is debated. Ogdie et al1 report associations between psoriasis, psoriatic arthritis (PsA), rheumatoid arthritis (RA) and an increased risk of major adverse cardiovascular events (MACE—myocardial infarction, stroke and cardiovascular death) in data derived from the UK primary care registry. Results are stratified by use of disease-modifying antirheumatic drugs (DMARDs). The risk for MACE appeared overall highest among patients with RA, and higher for DMARD users than non-users in RA and psoriasis. By contrast, combined risk of all outcomes was increased less in patients with PsA, and here, DMARD users had lower risks than non-DMARD users.
The statistical and epidemiological methods applied here are apparently sound, and important new information on increased cardiovascular risk in PsA, together with reaffirmation of earlier findings in psoriasis and RA, is presented. Limitations include their categorical adjustments for lipids and hypertension rather than adjustment for continuously measured risk factors. In addition, their somewhat arbitrary use of treatment (DMARDS) as a proxy marker of disease severity is challenging but pragmatic. On the one hand, those not receiving DMARDS should have lower disease activity, but, on the other, DMARDS attenuate inflammation and potentially lower vascular risk. There is also the possibility that some patients with PsA were missed and categorised as having …
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