Sustained Minimal Disease Activity in Psoriatic Arthritis Prevents Progression of Atherosclerosis

Sustained minimal disease activity should be maintained for a prolonged period in order to prevent progression of carotid atherosclerosis and arterial stiffness in patients with PsA.

Long-term control of inflammation and sustained achievement of minimal disease activity (MDA) is important to preventing progression of subclinical atherosclerosis and arterial stiffness in patients with psoriatic arthritis (PsA), independent of traditional cardiovascular (CV) risk factors, according to the results of a study published in Arthritis & Rheumatology.

In both PsA and rheumatoid arthritis (RA), the incidence of cardiovascular disease (CVD) and myocardial infarction are increased compared with the general population. Exposure to higher levels of inflammation in PsA is associated with more severe atherosclerosis and arterial stiffness.

To investigate the effects of achieving MDA on the progression of subclinical atherosclerosis and arterial stiffness in PsA, researchers conducted a prospective cohort study, including 101 consecutive patients with PsA. All patients received 2 years of treatment with either conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologic DMARDs (bDMARDs). The investigators performed annual assessments of atherosclerosis using high-resolution carotid ultrasound and arterial stiffness markers. The primary outcome was the effects of achieving MDA at 12 months on progression of subclinical atherosclerosis over a 24-month period.

Ninety patients completed the 24-month trial and were included in the analysis. At the 12-month evaluation, 63% of patients had achieved MDA and 46% of patients achieved sustained MDA. The multivariate analysis indicated that sustained MDA had a protective effect on progression of plaque (odd ratio [OR] 0.273; 95% CI, 0.088-0.846; P =.024). Sustained MDA also had positive effects on total plaque area, mean intima-media thickness, and augmentation index after adjustment of covariates.

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The authors noted this is the first longitudinal study to demonstrate that tight control of systemic inflammation and achievement of sustained MDA is associated with less progression of subclinical atherosclerosis and arterial stiffness. They also remarked that these findings support the European League Against Rheumatism recommendation that disease activity should be optimally controlled to lower the risk for CVD in patients with PsA. Additionally, some believe that bDMARDs may improve CV outcomes in comparison with csDMARDs.

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Cheng it, Shang Q, LI EK, et al. Can achieving minimal disease activity prevent progression of subclinical atherosclerosis and arterial stiffness? A prospective cohort study in psoriatic arthritis [published online August 25, 2018]. Arthritis Rheumatol. doi:10.1002/art.40695