The burden of carotid artery plaques is higher in patients with psoriatic arthritis compared with those with psoriasis alone.
OBJECTIVE
To compare the extent of atherosclerosis in patients with psoriatic arthritis (PsA) and patients with cutaneous psoriasis without arthritis (PsC).


METHODS
In this cross-sectional study the authors compared patients with PsA with PsC patients. Psoriasis patients underwent a rheumatological assessment to exclude inflammatory arthritis. Ultrasonographic measurements of carotid total plaque area (TPA) and carotid intima-media thickness (cIMT) were performed. t Test was used to compare the imaging findings between the two groups. Multivariate linear regression analysis was used to assess the association between disease status and imaging findings after adjusting for potential confounders.


RESULTS
Overall, 125 PsA and 114 PsC patients were compared. There were no significant differences in age, gender or cardiovascular risk factors between the two groups. Patients with PsA exhibited greater TPA than did PsC patients (TPA (square root of area in mm(2)) 3.33±3.34 vs 2.43±2.72, p=0.03). This difference remained statistically significant in the multivariate regression analysis after adjusting for potential confounders (p=0.03). The difference in cIMT between the groups did not achieve statistical significance (p=0.09). The following disease-related variables were associated with increase in TPA in multivariate regression analysis among PsA patients: duration of PsA (p=0.04), highest Psoriasis Area and Severity Index recorded in the first 3 years of follow-up (p=0.02) and erythrocyte sedimentation rate (p=0.005).


CONCLUSIONS
PsA patients suffer from more severe subclinical atherosclerosis compared with patients with PsC. This difference is independent of traditional cardiovascular risk factors and correlates with PsA disease duration, more severe skin disease and increased inflammatory markers.
Department of Rheumatology, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto Psoriatic Arthritis Program, Toronto, Ontario, Canada.
Lihi
L
Eder
Jai
J
Jayakar
Sutha
S
Shanmugarajah
Arane
A
Thavaneswaran
Daniel
D
Pereira
Vinod
V
Chandran
Cheryl F
CF
Rosen
Dafna D
DD
Gladman
D000368:Aged; D015535:Arthritis, Psoriatic / Q000453:epidemiology*; D015415:Biomarkers; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011565:Psoriasis / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index
D015415:Biomarkers