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Background: Patients with psoriatic arthritis (PsA) have been shown to be at increased risk of developing cardiovascular disease (CVD), with one recent meta-analysis demonstrating an increased CVD risk of 43% compared to the general population. However PsA is a heterogeneous disease consisting of five different clinical subtypes. It is not known whether the risk of CVD varies between different PsA subtypes.
Objectives: To determine whether particular subtypes of PsA are associated with an increased risk of cardiovascular disease.
Methods: 114 patients with PsA attending the University Hospital of Wales were asked to complete a questionnaire about their cardiovascular risk factors. Anthropometric and biochemical measurements, including blood pressure, body mass index (BMI), C-reactive protein (CRP) and cholesterol, were also performed. Patients were grouped into one of the five PsA subtypes as described by Moll and Wright. The QRISK2 algorithm was used to determine the 10 year risk of developing CVD for each patient. Multivariate analyses using linear and logistic regression with QRISK2 score and QRISK2 score >10% as dependent variables were conducted and adjusted for known cardiovascular risk factors.
Results: Symmetrical polyarthritis was the most common subtype, no patients had arthritis mutilans. There were no statistically significant differences between the subtypes with regards to age, gender, BMI, blood pressure, smoking status, cholesterol or CRP. Statistically significant differences were found between the subtypes using Chi-square (χ2) tests for QRISK2 score >10% (p=0.031) as well as the presence of existing cardiovascular disease, diabetes mellitus and cholesterol lowering treatment (p=0.021, 0.021 and 0.037 respectively). The table 1 below lists the number of patients by subtype and these variables.
Asymmetrical/oligo-articular |
Distal interphalangeal (DIP) predominant |
Spinal predominant |
Symmetrical polyarthritis |
|
|---|---|---|---|---|
n (out of 100) |
24 |
9 |
13 |
68 |
Age (mean±SD) |
51.3±15.0 |
61.4±7.8 |
58.8±13.7 |
50.7±15.2 |
Male (n,%) |
14 (58.3) |
5 (55.6) |
6 (46.2) |
32 (47.1) |
Presence of cardiovascular disease (n,%)* |
1 (4.2) |
0 (0) |
3 (23.1) |
1 (1.5) |
History of diabetes mellitus (n,%)* |
6 (25.0) |
2 (22.2) |
3 (23.1) |
3 (4.4) |
On cholesterol-lowering treatment (n,%)* |
4 (16.7) |
1 (11.1) |
6 (46.2) |
9 (13.2) |
QRISK2 risk score (mean±SD) |
12±12.3 |
15.1±8.5 |
18.8±13.9 |
11.1±13.3 |
Those with QRISK2 risk score>10% (n,%)* |
9 (37.5) |
7 (77.8) |
8 (61.5) |
23 (33.8) |
Conclusions: PsA patients with symmetrical polyarthritis appear to have the lowest risk of developing CVD. This subtype also had a significantly lower proportion of patients with coexisting diabetes mellitus. Patients with the distal interphalangeal (DIP) subtype are more likely to have existing CVD and be on cholesterol-lowering medications. Patients with the DIP and spinal predominant subtypes of PsA are also more likely to have a QRISK2 score of greater than 10% compared to the other PsA subtypes, suggesting they are more likely to develop CVD and may consequently need closer monitoring and management of CVD risk factors.
References:
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2018-eular.6035