Abstract
Psoriatic Arthritis (PsA) is an inflammatory arthritis associated with Psoriasis. Its recognition as an inflammatory disease distinct from Rheumatoid Arthritis has put forward for consideration several questions regarding its specific CVS mortality and morbidity (9, 11, 16, 26). Carotid intima media thickness is a useful surrogate and sensitive marker to determine atherosclerosis even in its subclinical stages (6, 14, 22, 27, 32). Prevalence of carotid intima media thickness in patients with Psoriatic arthritis is unknown in Asian population. We aim to identify the presence of subclinical atherosclerosis in patients with psoriatic arthritis and disease activity association and its predictors in a series of patients with PsA attended to the rheumatology clinic, tertiary hospitals. A total of 63 patients with PsA who fulfilled the CASPAR criteria were recruited from UKM Medical Centre and Hospital Putrajaya. Common carotid intima media thickness (IMT) was measured in both right and left carotid artery by using high resolution B-mode ultrasound. This was a cross sectional study first done in Malaysia for PsA patients. The positive IMT (IMT > 1.00 mm) among PsA was observed in 10 out of 63 patients (15.9 %) regardless of background cardiovascular risk. The mean +/- SD of IMT was 0.725 +/-0.260 mm for this study. Variables significantly associated with positive IMT (p < 0.05) included age at the time of study (p = 0.005), waist circumference (p = 0.001), Hypertension (p = 0.007), Diabetes (p = 0.002) and Metabolic syndrome (p = 0.001) and not associated with gender, ethnicity, duration of PsA disease, pattern of PsA, disease activity and severity. Above all, only age had positive IMT independent predictor (p = 0.032), with OR 1.116; 95 % CI (1.010-1.234). There was a significant association between CVS risk and positive Intima Media Thickness in Psoriatic Arthritis patients. Otherwise, there was no association in disease activity, disease severity and DMARDS therapy with positive Intima Media Thickness in Psoriatic Arthritis patients. The study was approved by Research and Ethics Committee of the faculty of medicine, Universiti Kebangsaan Malaysia with project code FF-114-2008 and by Community Research Center (CRC) of National Institutes of Health (NIH) for the case study in Hospital Putrajaya with the project code NMRR-08-970-2125.
Highlights
Psoriasis is a common and recurrent skin disorder, characterized by marked inflammatory changes in the epidermis and dermis especially among Caucasian (1–3 % prevalence), but uncommon in some other ethnic groups, such as Afro-Caribbeans and Native Americans (0–0.3 %)
Psoriatic arthritis (PsA) is defined by Moll and Wright as an „inflammatory arthritis associated with psoriasis, which is usually negative for rheumatoid factor“
Among all the psoriatic arthritis patients, 12 patients (19.0 %) had Diabetes, 14 patients (22.2 %) had Hypertension, 3 patients (4.8 %) had ischemic heart disease (IHD), 26 patients (41.3 %) had hyperlipidemia and 9 patients (14.3 %) were still actively smoking within 1 year of the study (Tab. 1). All of these psoriatic arthritis patients were on stain for a mean duration of 2.0±0.8 years
Summary
Psoriasis is a common and recurrent skin disorder, characterized by marked inflammatory changes in the epidermis and dermis especially among Caucasian (1–3 % prevalence), but uncommon in some other ethnic groups, such as Afro-Caribbeans and Native Americans (0–0.3 %). Psoriatic arthritis (PsA) is defined by Moll and Wright as an „inflammatory arthritis associated with psoriasis, which is usually negative for rheumatoid factor“. A group of experts under the acronym of CASPAR has proposed a set of psoriatic arthritis criteria in which the criteria includes the presence of inflammatory articular disease (joint, spine, enthesis) within 3 or more joints plus with the following: current psoriasis, personal history or family history of psoriasis (if current psoriasis is absent); current psoriatic nail dystrophy, negative rheumatoid factor, and/or current/ history of dactylitis (juxta-articular new bone formation) [31]. Numerous immunological factors identified as relevant in the pathogenesis of atherosclerosis are found in other chronic systemic inflammatory diseases such as in Rheumatoid Arthritis (RA) and psoriasis, as they shared pathogenic pathways. Several studies have been done, to evaluate the cardiovascular risk in inflammatory diseases which are mainly in rheumatoid arthritis (RA) but only a few studies done on non-RA and Psoriasis patients [1]. Tab. 5: Clinical characteristic of PsA patients with and without IMT positive (n=63) Bivariate Analysis (categorical data II).
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