POS1073 INCREASED NUMBER OF COMORBIDITIES AND CARDIOVASCULAR RISK FACTORS IN EARLY PSORIATIC ARTHRITIS PATIENTS SUGGESTS AN INTRINSIC DISEASE IMPACT.

Abstract

BackgroundMetabolic and cardiovascular comorbidities in psoriatic arthritis (PsA) are seen as a consequence of long-lasting inflammation. Patients with Pso and PsA develop metabolic and cardiovascular comorbidities over the course of time1. PsA patients have a higher burden of comorbidities and cardiovascular risk factors (CV RF) as compared to those with other forms of arthritis2,3. Despite a lower grade of systemic inflammation as measured by CRP, the nature of this increased prevalence in PsA is not fully understood. We hypothesize that the risks may be intrinsic to the disease, and be already present in early stages.ObjectivesThe aim of this study was to investigate the presence of comorbidities and CV RF in treatment naïve Early PsA (EPsA) as compared to sex- and age-matched healthy volunteers and to study factors contributing to the metabolic burden of the patients.MethodsClinical, demographic characteristics, cardiovascular risk factors and comorbidities of newly diagnosed treatment-naïve adult patients with PsA compared to sex- and age-matched controls were studied in an observational prospective longitudinal multicentre study.ResultsSixty-seven EPsA patients were matched to 61 healthy volunteers. At diagnosis, 73% of EPsA had oligoarticular and 22% polyarticular disease. Majority had mild PASI scores (median PASI 1.2). The median duration of skin psoriasis before the onset of PsA was 11.4 years. Symptom duration at onset of PsA was 0.6 years.EPsA showed a significantly higher rate of obesity (40.3% vs 18.3% in controls, p=0.011). PsA patients had significantly higher rates of dyslipidemia and metabolic syndrome than controls. Rate of insulin resistance, arterial hypertension, depression, COPD, gout were similar in EPsA and in controls.The overall number of comorbidities was comparable in EPsA and healthy controls, but strikingly 82% of EPsA patients had CV RF already present at baseline as compared to 38% of the controls (p=0.017). More than half of PsA patients had multiple (≥2) comorbidities and CV RF at baseline as compared to controls(33%) (Figure 1). Overall rate of cardiovascular morbidity and Charlson comorbidity index were low, but were significantly higher in the PsA group (p=0.007 and <0.001 accordingly). Duration of skin psoriasis had no effect on comorbidities or CV RF in EPsA.Figure 1.Comparison of comorbidities, CV RF, cardiovascular disease and Charlson comorbidity index in early PsA and healthy controls.In multiple regression analysis diagnosis of PsA was the strongly associated with the number of comorbidities and CV RF after adjusting for age, sex and BMI.ConclusionOur data imply that PsA patients have higher comorbidities and cardiovascular burden at early stages of the disease. Rates of dyslipidemia, metabolic syndrome and obesity are significantly higher in the early PsA population. Presence of metabolic and lipid disturbances at early stages of the disease might suggest a bidirectional relationship and potentially playing role as initial triggers of PsA.