A link between psoriasis, psoriatic arthritis, or rheumatoid arthritis and a higher chance of heart attacks, strokes, and other serious heart and circulation problems is confirmed in a detailed new study.

INTRODUCTION

At first glance psoriasis, psoriatic arthritis (arthritis caused by psoriasis), and rheumatoid arthritis (RA) don’t seem to have much in common with heart disease. After all, they affect very different parts of the body (the skin and joints as opposed to the heart and blood vessels). However, one thing that may link these illnesses is inflammation.
Inflammation is the body’s natural response to injuries (such as cuts, sprains, and broken bones), harmful substances (such as toxins), and germs (such as viruses). Inflammation usually lasts only a short time, helping us to heal or fight off an infection. However, sometimes inflammation lasts much longer and is not helpful, potentially causing damage to our tissues. This is what happens in psoriasis, psoriatic arthritis, and RA.
Many previous studies have suggested that conditions that cause this long-term (chronic) inflammation can also increase the chance of other serious health problems, including heart disease. Nonetheless, there are still gaps in our knowledge about the link between heart disease and these illnesses.

WHAT DID THE RESEARCHERS HOPE TO FIND?

The researchers wanted to explore whether people with RA, psoriasis, or psoriatic arthritis were more likely to have heart attacks and other serious problems related to heart disease than people without these conditions. They were particularly interested in the possible link with psoriatic arthritis, as not much research has explored this.

WHO WAS STUDIED?

Using a UK database of health records the researchers looked at more than 8,700 people with psoriatic arthritis, 41,700 people with RA, and 138,400 people with psoriasis (but not psoriatic arthritis). They also looked at more than 81,500 people who did not have any of these conditions. All of the people were aged 18 to 89.

HOW WAS THE STUDY CONDUCTED?

The researchers followed the people for an average of five years to see whether those with RA, psoriasis, or psoriatic arthritis were more likely to have serious heart and circulation problems than those without these conditions. In particular, the researchers looked at whether people had a heart attack, a stroke, or died of a heart or circulation problem.
They also wanted to explore whether people with more severe RA, psoriasis, or psoriatic arthritis had a higher chance of these problems. To do this they looked at whether people were taking disease-modifying antirheumatic drugs (DMARDs). These medicines are often used by people with more severe cases of these illnesses.

WHAT DOES THE NEW STUDY SAY?

During the study, people who had RA, psoriasis, or psoriatic arthritis were more likely than those without those conditions to have serious heart and circulation problems. The chance of problems varied depending on whether people were taking a DMARD.
▸ Overall, the increased chance of heart and circulation problems was highest among people with RA. Those not taking a DMARD had nearly a 40 percent higher chance of these problems, while those taking a DMARD had nearly a 60 percent higher chance.
▸ People with psoriasis had nearly a 10 percent higher chance of these problems if they did not take a DMARD, and around a 40 percent higher chance if they did.
▸ People with psoriatic arthritis had more than a 20 percent higher chance of these problems if they did not take a DMARD. But those who did take a DMARD did not have an increased chance of these problems.

HOW RELIABLE ARE THE FINDINGS?

This was a very large study that used a reliable database to follow people’s health over time. The researchers also took into account many things that can affect a person’s chance of serious heart and circulation problems, such as their age, whether they smoked, and whether they had high blood pressure, high cholesterol, or  diabetes. This makes it more likely that the link with RA, psoriasis, and psoriatic arthritis is genuine. It’s also worth noting that earlier studies looking at people with RA and psoriasis have had similar findings.
However, the researchers had to make certain assumptions to arrive at their results. Notably, they assumed that people who used DMARDs had more severe illnesses than those who didn’t take these medicines. But this may not always have been the case.

WHAT DOES THIS MEAN FOR ME?

If you have RA, psoriasis, or psoriatic arthritis, these findings may sound alarming. But it’s important to put them in perspective. If your chance of serious heart and circulation problems is generally low – say, a 2 percent (2 in 100) chance – then a 50 percent increase would raise it to only 3 percent (a 3 in 100 chance).
That’s not to say that these findings aren’t important, particularly if you already have a raised chance of heart and circulation problems for other reasons. The good news is that you can take steps to lower your risk – for example, by eating a healthy diet, exercising regularly, not smoking, and keeping your blood pressure and cholesterol at healthy levels. You can discuss how best to lower your risk with your doctor.

Disclaimer: This is a summary of a scientific article written by a medical professional (“the Original Article”). The Summary is written to assist non medically trained readers to understand general points of the Original Article.  It should not be relied on in any way whatsoever, (which also means the Summary is not medical advice), and is simply supplied to aid a lay understanding of general points of the Original Article. It is supplied “as is” without any warranty. You should note that the Original Article (and Summary) may not be accurate as errors can occur and also may be out of date as medical science is constantly changing.  It is very important that readers not rely on the content in the Summary and consult their medical professionals for all aspects of their health care. Do not use this Summary as medical advice even if the Summary is supplied to the reader by a medical professional.
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Date summary prepared: February 2015

Summary based on research article published on: 28 October 2014

From: Ogdie A, Yu Y, Haynes K, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis 2015;74:326–32. doi:10.1136/annrheumdis-2013-205675LaySummary Date prepared: April 2015

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