Examining the Implications of Accelerated Coronary Plaque Formation in Psoriatic Arthritis

Coronary Heart Disease Plaque Mortality
Coronary Heart Disease Plaque Mortality
Disease severity and activity in psoriatic arthritis may predict coronary plaque burden better than traditional risk factors.

Patients with well-established psoriatic arthritis (PsA) without symptoms or a diagnosis of coronary artery disease (CAD) had a higher coronary plaque burden compared with healthy control patients, which may be associated with underlying disease activity, according to the results of a single-center, controlled study conducted in Ireland and published in Arthritis & Rheumatology.

Investigators sought to examine the effects of the metabolic syndrome and psoriatic disease-related variables on coronary plaque formation in patients with PsA. A total of 50 patients with PsA and no symptoms of CAD (25 with metabolic syndrome and 25 without metabolic syndrome) and 50 age- and sex-matched control patients underwent 64-slice coronary computed tomography angiography. In all participants, plaque localization, segment involvement score, stenosis severity score, and total plaque volume were calculated. The plaques were classified as calcified plaques, mixed plaques, or noncalcified plaques.

Coronary artery involvement was significantly higher in patients with PsA compared with control patients (76% vs 44%, respectively; P =.001). Prevalence of 1-vessel, 2-vessel, and 3-vessel disease was reported significantly more often in patients with PsA (42%, 14%, and 20%, respectively) than in control patients (20%, 14%, and 10%, respectively; P =.007). Moreover, the proportion of participants with coronary plaques was significantly higher in patients without metabolic syndrome (80%) than in control patients (P =.003).

Only 22% of patients with PsA were stenosis free compared with 56% of control patients (P =.001). In addition, more patients with PsA had moderate to severe stenosis compared with control patients (22% vs 6%, respectively; P =.044). Mean quantitative plaque scores were all significantly higher in patients with PsA compared with control patients (segment involvement score: P =.003; stenosis severity score: P =.001; total plaque volume: P < .001). More patients with PsA had mixed plaques compared with control patients (P <.001), both in those with metabolic syndrome (P =.009) and in participants without metabolic syndrome (P <.001).

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“[W]e found that patients with well-established PsA without symptoms or diagnosis of CAD had a higher extent of coronary plaques…compared to controls,” the investigators concluded. “Our results suggest that accelerated formation of coronary plaques in PsA may associate with underlying disease activity and severity but is independent of features of metabolic syndrome.”

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Szentpetery A, Healy GM, Brady D, et al. Higher coronary plaque burden in psoriatic arthritis is independent of metabolic syndrome and associated with underlying disease severity [published online November 28, 2017]. Arthritis Rheumatol. doi: 10.1002/art.40389