Achieving minimal disease activity in psoriatic arthritis lowers CV risk
In patients with psoriatic arthritis, those who achieve sustained minimal disease activity (sMDA) may have a lower cardiovascular (CV) risk than those who do not.
This is based on a recent study conducted by the Chinese University of Hong Kong (CUHK), which showed significant improvement in carotid intima-media thickness (CIMT) in patients who achieved sMDA compared with those who did not. [Arthritis Rheumatol 2018, doi: 10.1002/art.40695]
“We hope to demonstrate the importance of suppressing inflammation in patients with psoriatic arthritis, which reduces the impact of CV disease on the patients and the associated medical burden,” highlighted Professor Lai-Shan Tam of CUHK’s Division of Rheumatology.
Tam and colleagues from CUHK’s Division of Rheumatology and Division of Cardiology recruited 90 patients with psoriatic arthritis for the study. All patients received therapy for 2 years according to a treatment protocol with the aim of achieving minimal disease activity (MDA). Their CIMT and carotid plaque were assessed at baseline, 12 months, and 24 months. The primary aim of the study was to investigate the effects of achieving MDA at 12 months on the progression of subclinical atherosclerosis over a period of 24 months.
Among the 90 patients included in the study, 57 (63 percent) achieved MDA at 12 months, and 41 (46 percent) achieved sMDA (defined as MDA at each visit from months 12 to 24).
Mean CIMT between baseline and month 24 was significantly reduced in patients who achieved sMDA vs those who did not (-0.04 ± 0.06 mm vs -0.01 ± 0.08 mm; p=0.031). Subclinical atherosclerosis and arterial stiffness outcomes were similar between the MDA and non-MDA groups.
In multivariate analysis, achievement of sMDA in psoriatic arthritis had a protective effect on plaque progression (odds ratio, 0.273; 95 percent confidence interval [CI], 0.088 to 0.846; p=0.024). sMDA was also associated with less increase in total plaque area (β=-3.919; 95 percent CI, -7.181 to -0.657; p=0.019), mean intima-media thickness (β=-0.037; 95 percent CI, -0.066 to -0.007; p=0.014), and augmentation index (β=-3.059; 95 percent CI, -6.067 to 0.051; p=0.046) in the patients.
“Our study shows that achieving sMDA helps protect the CV system of patients with psoriatic arthritis and reduce their risk of atherosclerosis,” said Tam. “This may be due to the fact that patients with sMDA are less likely to develop bouts of uncontrolled and sustained systemic inflammation, which contribute to atherosclerosis and CV diseases.”
“In our study, plaque progression was still observed in around 30 percent of patients in the sMDA group,” she added. “In addition to achieving sMDA, these patients must pay attention to other traditional CV risk factors to prevent complications.”
“Traditional CV risk factors, such as hypertension and dyslipidaemia, are common in patients with psoriatic arthritis. These patients also have a very high level of inflammation,” explained investigator Dr Alex Lee of the Division of Cardiology, CUHK. “All these factors weaken their CV health. Therefore, it is essential to intervene at an early stage to minimize disease activity.”