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Background Prevalence of comorbidities and cardiovascular risk factors in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) is higher than in general population. Chronic systemic inflammation is perceived as a major cause of increased comorbid conditions. Obesity and certain metabolic disturbances are present at early stages of the PsA suggesting a link between certain comorbidities and PsA at a pathophysiological level.
Objectives The aim of the study was to investigate which comorbidities contribute to metabolic burden and cardiovascular morbidity in early PsA and to compare the rate of comorbidities to sex and age matched healthy volunteers and early RA patients.
Methods Clinical, demographic data and comorbidities were collected from patients with PsA (all CASPAR positive), RA (all 2010 ACR positive) from two prospective multicenter cohorts (METAPSA&CARRERA) and from healthy volunteers (matched by sex and age). Patients were naïve to DMARD treatment and had symptom duration of < 2 years.
Results Patients with PsA (67) and RA (50) were compared to healthy volunteers (61) (Table 1). The overall number of comorbidities was high in PsA (74.6%), RA (66.7%) and control group (60.7%) (p=0.238). However, more PsA patients had multiple comorbidities than RA patients and controls (p=0.007). PsA and RA patients had above normal BMI, higher than matched controls. RA group had a higher proportion of smokers than PsA group and controls. Number of patients having cardiovascular risk factors was higher in PsA (82.1%) and in RA (88.9%) as compared to controls (62.3%) (p=0.003). The most frequent comorbidity was dyslipidemia in both RA and PsA. The rate of hyperuricemia and depression were significantly higher in PsA than in RA and controls. The rate of obesity, type 2 diabetes mellitus, arterial hypertension, COPD, gout, malignancy was similar in PsA and RA but higher than in controls. Patients with PsA had higher Charlson comorbidity index and higher rate of cardiovascular disease as compared to RA and control group (p=0.005).
Conclusion In conclusion, patients with PsA have a high cardiovascular and metabolic burden already at early stages of the disease. They have higher rate of multiple comorbidities and higher of cardiovascular morbidity as compared to age-matched early RA patients despite comparable BMI and similar rates of obesity. This suggests that metabolic disturbances, present at early stages of PsA might be linked to PsA at a pathophysiological level.
| early PsA (n=67) | early RA (n=50) | 2-sided significance |
healthy controls, (n=61) | F-value/ |
2-sided significance |
|
|---|---|---|---|---|---|---|
| age, years, mean (±SD) | 47.9 (±14.3) | 51.4 (±14.6) | 0.905 | 45 (±14.2) | 2.8 | 0.063 |
| BMI, mean (±SD) | 28.2 (±4.5) | 27 (±4.7) | 0.535 | 25.8 (±5.2) | 4.5 | 0.013 |
| sex, male, n (%) | 47 (70.1) | 14 (28) | <0.001 | 35 (57.4) | 20.9 | <0.001 |
| TJC68, median (IQR) |
2 (1-5) |
12 (0) |
<0.001 <0.001 | |||
| CRP, mg/l, median (±IQL) | 3.6 (8.6) | 4.8 (11.1) | 0.371 | 0.9 (1.7) | 5.9 | 0.003 |
| comorbidities ≥2, n patients (%) |
35 (52.2) |
13 (28.9) |
0.0190.338 | 17 (27.9) |
10 |
0.007 0.002 |
| Smoking, n (%) | 16 (23.9) | 30 (60) | <0.001 | 4 (6.6) | 39.8 | <0.001 |
| dyslipidemia, n patients (%) | 45 (67.2) | 19 (67.9)£ | 1.0 | 25 (41) | 10.6 | 0.005 |
| obesity | 27 (40.3) | 14 (28) | 0.178 | 11 (18.3) | 7.4 | 0.024 |
| type 2 diabetes mellitus, n patients (%) | 8 (11.9) | 4 (8.9) | 0.759 | 1 (1.6) | 5.0 | 0.08 |
| arterial hypertension | 19 (28.4) | 7 (15.6) | 0.17 | 12 (19.7) | 2.9 | 0.239 |
| Abnormal liver tests | 8 (11.9) | 4 (8) | 0.553 | 2 (3.3) | 3.3 | 0.191 |
| Hyperuricemia, n patients (%) | 8 (11.9) | 0 | 0.021 | 5 (8.2) | 5.6 | 0.061 |
| COPD | 2 (3) | 0 | 0.515 | 1 (1.6) | 1.4 | 0.493 |
| Depression | 8 (11.9) | 0 | 0.021 | 2 (3.3) | 8.1 | 0.017 |
| cardiovascular disease, n patients (%) | 14 (20.9) | 1 (2.2) | 0.042 | 4 (6.6) | 16 | 0.043 |
| Charlson Comorbidity Index≥1, n patients (%) |
21 (31.3) |
8 (17.8) |
0.042 0.004 | 4 (6.6) |
12.9 |
0.005 <0.001 |
REFERENCES:
NIL.
Acknowledgements: NIL.
Disclosure of Interests None Declared.
Keywords: Rheumatoid arthritis, Psoriatic arthritis, Comorbidities
DOI: 10.1136/annrheumdis-2023-eular.6364