Cardiovascular Morbidity in Psoriatic Arthritis: What Is the Effect of Inflammation?

The association between chronic inflammatory arthritis and cardiovascular (CV) morbidity is well established. Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis are at increased risk for CV morbidity and mortality1. This risk remains high even after accounting for traditional CV risk factors, which highlights the potential role of chronic inflammation and its interaction with conventional risk factors in promoting atherosclerosis. However, much of the knowledge about CV comorbidities in rheumatic patients, its epidemiology, and its underlying mechanisms comes from studies in patients with RA, while such data are limited in PsA. While some overlap can be found between PsA and RA in clinical features, treatment modalities, and underlying proinflammatory mechanisms, major differences exist between these 2 conditions. For example, PsA differs from RA in its demographics, the characteristics and extent of involvement of extraarticular tissues, the lack of autoantibodies, and the primary role that the interleukin (IL)-17/IL-23 pathway plays in disease evolution. These differences may affect CV risk and support the need for specific studies evaluating CV morbidity in patients with PsA. The study by Agca, et al 2 in the current issue of The Journal assesses the effect of etanercept (ETN), an inhibitor of tumor necrosis factor-α (TNF-α), on lipid levels and other CV risk factors in patients with PsA and thus addresses some of these gaps in knowledge. What do we know about CV morbidity in PsA? It is accepted that the prevalence of CV disease (CVD) is elevated in patients with psoriasis and PsA compared with the general population. A recent metaanalysis found that CV morbidity is increased by 43% in patients with PsA3. The prevalence of established CV risk factors, such as metabolic syndrome, diabetes, hypertension, and dyslipidemia, is also elevated in psoriatic patients4, which raises the … Address correspondence to Dr. L. Eder, Toronto Western Hospital, Centre for Prognosis Studies in The Rheumatic Diseases, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada. E-mail: leder{at}uhnresearch.ca, benlihi{at}gmail.com

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