Polyarticular evolution and late-onset psoriasis may be associated with cardiovascular disease in psoriatic arthritis

Int J Rheum Dis. 2019 Feb;22(2):269-274. doi: 10.1111/1756-185X.13421. Epub 2018 Nov 5.

Abstract

Background and aims: Patients with psoriatic arthritis (PsA) have high prevalence of cardiovascular risk factors (CVRF), and they also show higher rates of cardiovascular disease (CVD). We aimed to corroborate these findings and identify factors associated with these events in our clinical setting.

Methods: This cross-sectional study included 340 consecutive patients seen in a tertiary care hospital. The prevalence of CVRF was compared to that of 600 outpatients without inflammatory conditions. To analyze CVD-associated factors, odds ratio (OR) values were calculated by conditional logistic regression analysis. Significant variables in the univariate analysis were then introduced in a multivariate analysis with a backward stepwise approach.

Results: Patients with psoriatic arthritis had higher frequencies of hypertension (36% vs 23%, OR 2.4, 95%CI: 1.6-2.7, P < 0.0001), diabetes (13.8% vs 5%, OR 2.8, 95%CI: 1.7-4.3, P < 0.0001), obesity (35% vs 22%, OR 2.1, 95%CI: 1.5-2.8, P < 0.0001) and tobacco use (26% vs 21%, OR 1.4, 95%CI: 1.0-1.8, P < 0.05). More PsA patients had CVD compared to non-inflammatory patients (9.4% vs 5.8%, OR 1.68, 95%CI: 1.02-2.76, P < 0.05). Independent CVD-associated factors were: an age of onset of psoriasis >40 years (OR 3.4, 95%CI: 1.1-10.0, P < 0.05), a high number of swollen joints during evolution (OR 2.9, 95%CI: 1.1-8.0, P < 0.05), hypertension (OR 5.3, 95%CI: 1.6-17.6, P < 0.01) and dyslipidemia (OR 2.6, 95%CI: 1.0-7.2, P < 0.05).

Conclusions: Cardiovascular risk should be carefully evaluated in patients with PsA whose disease presents a high inflammatory burden and in those with late-onset psoriasis.

Keywords: cardiovascular risk; polyarthritis; psoriasis; psoriatic arthritis; risk factors.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Aged
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Psoriatic / blood
  • Arthritis, Psoriatic / diagnosis
  • Arthritis, Psoriatic / drug therapy
  • Arthritis, Psoriatic / epidemiology*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology*
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Humans
  • Inflammation Mediators / blood
  • Joints / drug effects
  • Joints / pathology
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Skin / drug effects
  • Skin / pathology
  • Spain / epidemiology
  • Tertiary Care Centers
  • Time Factors
  • Young Adult

Substances

  • Antirheumatic Agents
  • Inflammation Mediators