Patients with well-established psoriatic arthritis (PsA) without any symptoms or a diagnosis of coronary artery disease (CAD) have a higher burden of coronary plaques, which may be linked to underlying disease activity and severity, but is independent of features of metabolic syndrome, according to the results of a single-center, controlled, cohort study recently published in Arthritis & Rheumatology.
The investigators sought to examine the effect of metabolic syndrome and psoriatic disease-related variables on coronary plaque burden in patients with PsA. A total of 50 patients with PsA and no symptoms of CAD were enrolled in the study, including 25 with metabolic syndrome and 25 without metabolic syndrome, along with 50 age-matched, sex-matched control patients selected retrospectively from a cohort of patients with no history of CAD. The participants underwent 64-slice coronary computed tomography angiography. Researchers calculated plaque localization, segment stenosis score, segment involvement score, and total plaque volume. Plaque type was classified as calcified, mixed, or noncalcified.
Coronary artery involvement, or presence of plaques, was reported in a significantly higher number of patients with PsA than in control patients (76% vs 44%, respectively; P =.001). In patients with PsA, 1-vessel, 2-vessel, and 3-vessel disease was reported in 42%, 14%, and 20% of participants, respectively, compared with 20%, 14%, and 10% of control patients (P =.007). Moreover, the proportion of individuals with coronary plaques was significantly higher among patients with PsA without metabolic syndrome (80%) compared with control patients (P =.003), and it was similar to that in patients with PsA and metabolic syndrome (72%).
Segment stenosis score, segment involvement score, and total plaque volume were all significantly greater in participants with PsA vs control patients (P =.001, P =.003, and P ≤.001, respectively). More patients with PsA had mixed plaques, and the mixed plaque volume was significantly higher among participants with PsA compared with control patients (P <.001).
Patients with and without metabolic syndrome had similar plaque burdens and types of plaques. Segment stenosis score, segment involvement score, and total plaque volume were not significantly associated with features of disease activity, but were significantly associated with disease activity measures. Total plaque volume was significantly associated with a PsA diagnosis (P =.008), but not with presence of metabolic syndrome. Age, highest swollen joint count, disease duration, highest C-reactive protein level, and plasma glucose level were all independent predictors of higher plaque burden among participants with PsA.
The investigators concluded that PsA is associated with accelerated plaque formation, especially mixed plaques, which is independent of the presence of metabolic syndrome. It has been suggested that this accelerated plaque formation may be linked to underlying disease activity and disease severity in individuals with PsA.
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 February 6, 2018]. Arthritis Rheumatol. doi:10.1002/art.40389.