People with psoriatic arthritis have increased prevalence, burden and severity of coronary atherosclerosis.
INTRODUCTION
Psoriatic arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. The disease often causes swelling of the fingers and toes, mainly because of joint inflammation. It gets its name from the link between this type of arthritis and a skin condition called psoriasis, which causes skin redness and scaling.
Psoriatic arthritis is linked to an increased risk of blocked arteries (also called atherosclerosis). Atherosclerosis happens when your arteries become clogged with fat (also called plaques). This can make you more likely to get cardiovascular diseases such as heart attacks or strokes. Doctors need to be able to identify people at high risk of getting cardiovascular diseases so that they can give lifestyle advice and any treatment that might be needed. However, it has been reported that the normal risk assessment scores that doctors use might underestimate the risk in people with psoriatic arthritis.
Coronary computed tomography angiography (shortened to CCTA) is a type of imaging technique that can be used to help doctors see whether people have atherosclerosis in their heart.
WHAT DID THE AUTHORS HOPE TO FIND?
The authors wanted to use CCTA to look at the differences in coronary atherosclerosis in people with and without psoriatic arthritis.
WHO WAS STUDIED?
The study looked at 90 people with psoriatic arthritis who had appointments at a clinic in Hong Kong. None of the people included had previously been diagnosed with a cardiovascular disease.
HOW WAS THE STUDY CONDUCTED?
This was an observational study, and there was no treatment being investigated. Everyone had a CCTA scan to see if they had any atherosclerosis in their heart. The results were compared to the medical records of 240 people who did not have psoriatic arthritis and who had been scanned at the same hospital.
WHAT WERE THE MAIN FINDINGS OF THE STUDY?
The study found that, in total, people with psoriatic arthritis had almost four-times as many fatty plaques in their heart as people without psoriatic arthritis. Overall, 60% of people with psoriatic arthritis had at least one plaque in their heart, compared with only 35% of people without the disease. The plaques were also more severe in people with psoriatic arthritis than people without the disease. This probably explains why people with psoriatic arthritis get more heart attacks than healthy people. This means that people with psoriatic arthritis often have cardiovascular problems that they do not know about.
Based on the results of this study, the authors suggest that people with psoriatic arthritis should have their cardiovascular risk better assessed, especially if they have had their disease for a long time.
ARE THESE FINDINGS NEW?
Yes, this is the first study looking at atherosclerosis in the hearts of people with psoriatic arthritis compared to people without.
WHAT ARE THE LIMITATIONS OF THE STUDY?
There were some limitations in this study. The medical records of the people without psoriatic arthritis were historical ones, which could make it hard to repeat the results of this study. However, the authors are confident that the people chosen were appropriate, and they stated that the investigators could not see each person’s CCTA results during the selection process. Another limitation is that, because of the way the study was designed, it was not possible to make a link between CCTA results and any cardiovascular events that people may have gone on to have afterwards. Finally, the people included had moderate or mild psoriatic arthritis, which might mean that the overall number and severity of plaques may not be the same in people with worse disease.
WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
There is another study ongoing to see whether people with psoriatic arthritis who achieve sustained minimal disease activity have reduced levels of atherosclerosis in their hearts. Another study is also being planned which will see whether using ultrasound could help to work out the cardiovascular risk in people with types of inflammatory arthritis.
WHAT DOES THIS MEAN FOR ME?
If you have psoriatic arthritis, you should be aware that you have an increased risk of getting atherosclerosis and cardiovascular problems, even if you do not notice any chest pain. Your doctor should monitor your risk factors and treat you with drugs to lower your blood pressure or reduce your cholesterol, if you need it. Your doctor may also make suggestions about how you can look after your heart yourself, for example, by reducing your weight, taking regular exercise or stopping smoking.
Controlling the inflammatory activity of your psoriatic arthritis could also help to reduce your cardiovascular risks. If you are taking medicine for your psoriatic arthritis, you should make sure that you take it as prescribed to get the best possible effects.
If you have any concerns, you should talk to your doctor.
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Date prepared: July 2017
Summary based on research article published on: 4 January 2017 From: Shen, J. et al. Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease. Ann Rheum Dis 2017;76(7):1237–1244. doi:10.1136/annrheumdis-2016-210390
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