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Caso F, Fatica M, Ferraioli M, Megna M, Potestio L, Ruggiero A, Tommasino N, Maione F, Scarpa R, Chimenti MS, Costa L. The role of bDMARDs in the prevention and treatment of inflammatory-related comorbidities in Psoriatic Arthritis. Expert Opin Biol Ther 2024; 24:719-731. [PMID: 39037828 DOI: 10.1080/14712598.2024.2384090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/21/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is an immune-inflammatory disease that affects both joints and entheses, and with diverse extra-articular manifestations (psoriasis, inflammatory bowel disease (IBD), and uveitis). A wide range of comorbid conditions, including cardiovascular diseases, obesity, metabolic syndrome (MetS), nonalcoholic fatty liver disease (NAFLD), mental health disorders (depression/anxiety), and osteoporosis are highly prevalent in course of PsA.Biological DMARDs (bDMARD), including TNF-inhibitors (TNFi), Interleukin (IL-17i) and IL-23i represent the cornerstone of the management of active disease. The use of these therapies obviously requires considering comorbidities presence, safety aspects and contraindications. AREAS COVERED The aim of this review is to describe the inflammatory mechanisms behind PsA comorbidities, and the role of bDMARDs in the prevention and treatment of these conditions in course of PsA. EXPERT OPINION Tailoring therapeutic strategies to the individual characteristics of each PsA patient can be an effective approach to manage comorbidities, maximizing the efficacy of bDMARDs, and reducing the incidence of AEs. Identifying targets within disease pathways can guide research into therapeutics that address both PsA and comorbidities simultaneously, but more studies are advocated for clarifying the potential prevention and management of bDMARDs used for PsA.
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Affiliation(s)
- Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Mauro Fatica
- U.O.C. Reumatologia, Dipartimento di Medicina dei Sistemi, Universitá di Roma "Tor Vergata", Roma, Italy
| | - Mario Ferraioli
- U.O.C. Reumatologia, Dipartimento di Medicina dei Sistemi, Universitá di Roma "Tor Vergata", Roma, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Angelo Ruggiero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Nello Tommasino
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Francesco Maione
- ImmunoPharmaLab, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Sole Chimenti
- U.O.C. Reumatologia, Dipartimento di Medicina dei Sistemi, Universitá di Roma "Tor Vergata", Roma, Italy
| | - Luisa Costa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Kristensen LE, Deodhar A, Leung YY, Vranic I, Mortezavi M, Fallon L, Yndestad A, Kinch CD, Gladman DD. Risk Stratification of Patients with Psoriatic Arthritis and Ankylosing Spondylitis for Treatment with Tofacitinib: A Review of Current Clinical Data. Rheumatol Ther 2024; 11:487-499. [PMID: 38696034 PMCID: PMC11111604 DOI: 10.1007/s40744-024-00662-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/08/2024] [Indexed: 05/23/2024] Open
Abstract
In this commentary, we review clinical data which helps inform individualized benefit-risk assessment for tofacitinib in patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS). ORAL Surveillance, a safety trial of patients ≥ 50 years of age with rheumatoid arthritis (RA) and cardiovascular risk factors, found increased rates of safety outcomes (including major adverse cardiovascular events [MACE], malignancies excluding non-melanoma skin cancer, and venous thromboembolism) with tofacitinib versus tumor necrosis factor inhibitors (TNFi). Post hoc analyses of ORAL Surveillance have identified subpopulations with different relative risk versus TNFi; higher risk with tofacitinib was confined to patients ≥ 65 years of age and/or long-time current/past smokers, and specifically for MACE, patients with a history of atherosclerotic cardiovascular disease (ASCVD). In patients without these risk factors, risk differences between tofacitinib and TNFi could not be detected. Given differences in demographics, pathophysiology, and comorbidities, we sought to examine whether the risk stratification observed in RA is also appropriate for PsA and AS. Data from the PsA tofacitinib development program show low absolute risk of safety outcomes in patients < 65 years of age and never smokers, and low MACE risk in patients with no history of ASCVD, consistent with results from ORAL Surveillance. No MACE, malignancies, or venous thromboembolism were reported in the tofacitinib AS development program. The mechanism of the ORAL Surveillance safety findings is unknown, and there are no similar prospective studies of sufficient size and duration. Accordingly, it is appropriate to use a precautionary approach and extrapolate differentiating risk factors identified from ORAL Surveillance (age ≥ 65 years, long-time current/past smoking, and history of ASCVD) to PsA and AS. We recommend an individualized approach to treatment decisions based on these readily identifiable risk factors, in line with updated labeling for Janus kinase inhibitors and international guidelines for the treatment of PsA and AS.Trial Registration: NCT02092467, NCT01262118, NCT01484561, NCT00147498, NCT00413660, NCT00550446, NCT00603512, NCT00687193, NCT01164579, NCT00976599, NCT01059864, NCT01359150, NCT02147587, NCT00960440, NCT00847613, NCT00814307, NCT00856544, NCT00853385, NCT01039688, NCT02281552, NCT02187055, NCT02831855, NCT00413699, NCT00661661, NCT01877668, NCT01882439, NCT01976364, NCT00678210, NCT01710046, NCT01241591, NCT01186744, NCT01276639, NCT01309737, NCT01163253, NCT01786668, NCT03502616.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
- Copenhagen University, Copenhagen, Denmark.
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA
| | - Ying-Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | | | | | | | | | | | - Dafna D Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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Alunno A, Carubbi F, Rodríguez-Carrio J, Gossec L, Donohoe S, Ferri C. The management of cardiovascular risk in psoriatic disease: A bridge over troubled water. Semin Arthritis Rheum 2024; 65:152389. [PMID: 38325054 DOI: 10.1016/j.semarthrit.2024.152389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 02/09/2024]
Abstract
Evidence that psoriatic disease is burdened by an excess cardiovascular (CV) risk has accrued, however many questions remain unanswered. Although an interplay between traditional risk factors inflammation, disease activity and pharmacological therapies, as observed in rheumatoid arthritis (RA), may account for this increased risk, metabolic comorbidities rather than inflammation seem to have a leading role in psoriatic disease. Therefore, specific approaches, risk factors targeting and the importance of traditional risk factors and inflammation management need to be considered. The purpose of this review article is to discuss current data on CV risk in psoriatic disease, and to outline similarities and differences with RA in the light of international recommendations. Arguments in favour of developing specific guidance for CV prevention in psoriatic disease are discussed.
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Affiliation(s)
- Alessia Alunno
- University of L'Aquila, Department of Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy.
| | - Francesco Carubbi
- University of L'Aquila, Department of Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Faculty of Medicine, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris France; AP-HP, Pitié-Salpêtrière hospital, Rheumatology department, Paris, France
| | | | - Claudio Ferri
- University of L'Aquila, Department of Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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Meng H, Lam SH, So H, Tam LS. Incidence and risk factors of major cardiovascular events in rheumatoid arthritis and psoriatic arthritis: A population-based cohort study. Semin Arthritis Rheum 2024; 65:152416. [PMID: 38368730 DOI: 10.1016/j.semarthrit.2024.152416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/21/2023] [Accepted: 02/02/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To evaluate the incidence and risk factors of major adverse cardiovascular events (MACE) in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients. METHODS A population-based retrospective cohort of RA and PsA patients was identified in a citywide database. All patients recruited from Jan 2006 to Dec 2015 were followed until the end of 2018. The outcome was the occurrence of a first MACE. Covariates of interest included traditional cardiovascular (CV) risk factors, inflammatory markers and pharmacotherapies. The independent predictors of MACE were identified by the time-dependent cox proportional hazard models. RESULTS A total of 13,905 patients (12,233 RA and 1,672 PsA) were recruited. After a total of 119,571 patient-years of follow-up, 934 (6.7%) patients developed a first MACE. RA and PsA patients had similar adjusted incidence (incidence rate ratio 0.96, 95 % CI 0.75-1.22, p = 0.767). After adjusting for traditional CV risk factors, the time-varying erythrocyte sedimentation (ESR) rate and C-reactive protein (CRP) levels, and the use of glucocorticoids were independently associated with higher risk of MACE in both the RA and PsA cohorts. In RA, the use of methotrexate and non-steroidal anti-inflammatory drugs (NSAIDs) were associated with fewer MACE. The use of biologic disease modifying anti-rheumatic drugs was not associated with MACE in both RA and PsA. CONCLUSION The incidence of MACE was similar in RA and PsA. Systemic inflammation and glucocorticoid use independently increased the risk of MACE in inflammatory arthritis, while methotrexate and NSAIDs use were protective against the development of MACE in RA.
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Affiliation(s)
- Huan Meng
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Steven H Lam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ho So
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Exarchou S, Di Giuseppe D, Klingberg E, Sigurdardottir V, Wedrén S, Lindström U, Turesson C, Jacobsson LTH, Askling J, Wallman JK. Mortality in patients with psoriatic arthritis in Sweden: a nationwide, population-based cohort study. Ann Rheum Dis 2024; 83:446-456. [PMID: 38049985 DOI: 10.1136/ard-2023-224965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES To compare all-cause mortality and causes of death between patients with psoriatic arthritis (PsA) and the general population in Sweden. METHODS Adults with at least one main PsA diagnosis (International Classification of Diseases-10: L40.5/M07.0-M07.3) from outpatient rheumatology/internal medicine departments 2001-2017 were identified from the National Patient Register. Each case was matched to five population comparator-subjects on sex/county/age at the case's first arthritis diagnosis. Follow-up ran from 1 January 2007, or from first PsA diagnosis thereafter, until death, emigration or 31 December 2018. Mortality was assessed overall, and stratified by sex and duration since diagnosis (diagnosis before/after 1 January 2007), using matched Cox proportional hazard regression (excluding/including adjustments for comorbidity) or Breslow test, as appropriate. Incidence rate ratios (IRR) of death, overall and stratified by sex/duration since diagnosis/age, as well as causes of death in PsA cases and comparator-subjects were also described. RESULTS All-cause mortality was elevated in PsA (HR: 1.11 (95% CI: 1.07 to 1.16); IRR: 1.18 (95% CI: 1.13 to 1.22)), mainly driven by increased risks in women (HR: 1.23 (95% CI: 1.16 to 1.30)) and cases with longer time since diagnosis (HR: 1.18 (95% CI: 1.12 to 1.25)). IRR of death were significantly increased for all ages except below 40 years, with the numerically highest point-estimates for ages 40-59 years. When adjusted for comorbidity, however, the elevated mortality risk in PsA disappeared. Causes of death were similar among PsA cases/comparator-subjects, with cardiovascular disease and malignancy as the leading causes. CONCLUSIONS Mortality risk in PsA in Sweden was about 10% higher than in the general population, driven by excess comorbidity and with increased risks mainly in women and patients with longer disease duration.
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Affiliation(s)
- Sofia Exarchou
- Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö, Sweden
| | - Daniela Di Giuseppe
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Valgerdur Sigurdardottir
- Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
- Department of Rheumatology, Falun Hospital, Falun, Sweden
| | - Sara Wedrén
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö, Sweden
- Department of Rheumatology, Skåne University Hospital Malmö, Malmö, Sweden
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Johan Askling
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital Lund, Lund, Sweden
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Sen R, Caplan L, Danila MI. Cardiovascular disease in spondyloarthritis: a narrative review of risk factors and the effect of treatments. Curr Opin Rheumatol 2024; 36:95-107. [PMID: 38126207 DOI: 10.1097/bor.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the recent evidence available regarding the epidemiology of cardiovascular disease in spondyloarthritis (SpA), including the effect of disease modifying drugs on cardiovascular risk. RECENT FINDINGS People with SpA suffer from an increased risk of cardiovascular disease compared to the general population. This elevated risk is explained by the high prevalence of traditional cardiovascular risk factors and inflammation from disease activity leading to endothelial dysfunction and accelerated atherosclerosis. Consequently, the American College of Cardiology/American Heart Association and the European League Against Rheumatism recommend enhanced cardiovascular risk screening in SpA patients. There is evidence from observational studies that methotrexate and tumor necrosis factor inhibitors reduce the risk of cardiovascular events in SpA. Unlike what is observed in the general population, the use of nonsteroidal anti-inflammatory drugs does not appear to increase cardiovascular disease risk in SpA. SUMMARY Cardiovascular diseases are increasingly recognized in patients suffering from SpA, especially axial SpA and psoriatic arthritis. Cardiovascular diseases can cause significant morbidity, mortality, and add to the overall disease burden. Disease modifying drugs may mitigate some of the cardiovascular risk; however, a multidisciplinary team is needed to monitor patients and improve cardiovascular health status.
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Affiliation(s)
- Rouhin Sen
- The University of Alabama Birmingham, Division of Clinical Immunology and Rheumatology
- Birmingham Veterans Affairs Medical Center (VAMC), Birmingham, Alabama
| | - Liron Caplan
- Rocky Mountain Regional VAMC
- University of Colorado, Division of Rheumatology, Aurora, Colorado, USA
| | - Maria I Danila
- The University of Alabama Birmingham, Division of Clinical Immunology and Rheumatology
- Birmingham Veterans Affairs Medical Center (VAMC), Birmingham, Alabama
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Ishchenko A, Pazmino S, Neerinckx B, Lories R, de Vlam K. Comorbidities in Early Psoriatic Arthritis: Data From the Metabolic Disturbances in Psoriatic Arthritis Cohort Study. Arthritis Care Res (Hoboken) 2024; 76:231-240. [PMID: 37667975 DOI: 10.1002/acr.25230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/11/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of comorbidities and cardiovascular (CV) risk factors (RFs) in treatment-naive patients with early psoriatic arthritis (ePsA) and to identify factors that contribute to metabolic burden in ePsA. METHODS This was an observational longitudinal multicenter cohort study. Clinical and demographic characteristics, CV RFs, and comorbidities were compared in patients newly diagnosed with psoriatic arthritis (PsA) and sex- and age-matched controls. In patients with PsA, comorbidities were reevaluated after one year's follow-up because the disease activity changed. RESULTS Sixty-seven patients with ePsA and 61 healthy volunteers were included. The rate of comorbidities was similar in patients with ePsA and in healthy controls; 82.1% of patients with ePsA had CV RFs at baseline as compared with 62.3% of healthy volunteers (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.14-2.0). Patients with ePsA had higher odds of having multiple (two or more) comorbidities (OR 1.9, 95% CI 1.2-3.0) and multiple CV RFs (OR 2.1, 95% CI 1.3-3.2) than the controls. Comorbidities or CV RFs in patients with ePsA were not influenced by duration of skin psoriasis. Dyslipidemia was the most prevalent comorbidity in the PsA cohort (64.2% vs 39.3% in controls; OR 1.7, 95% CI 1.2-2.5). Patients with ePsA had, on average, above normal body mass index (mean ± SD 28.82 ± 4.5) and a higher rate of obesity (40.3% vs 18.3% in controls; OR 1.9, 95% CI 1.1-3.2). After 1 year, although disease activity scores improved, the proportion of patients with comorbidities and CV RFs did not increase or drop. CONCLUSION Our data imply that patients with PsA already have higher comorbidities and CV burden at early stages of the disease, suggesting that these are not only a consequence of long-lasting disease and chronic systemic inflammation.
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Affiliation(s)
- Alla Ishchenko
- Ziekenhuis Netwerk Atwerpen, Antwerp, and University Hospitals Leuven, Leuven, Belgium
| | - Sofia Pazmino
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Barbara Neerinckx
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Rik Lories
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Kurt de Vlam
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
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Colaco K, Lee KA, Akhtari S, Winer R, Chandran V, Harvey P, Cook RJ, Piguet V, Gladman DD, Eder L. Derivation and Internal Validation of a Disease-Specific Cardiovascular Risk Prediction Model for Patients With Psoriatic Arthritis and Psoriasis. Arthritis Rheumatol 2024; 76:238-246. [PMID: 37691498 DOI: 10.1002/art.42694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 08/12/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To address suboptimal cardiovascular risk prediction in patients with psoriatic disease (PsD), we developed and internally validated a five-year disease-specific cardiovascular risk prediction model. METHODS We analyzed data from a prospective cohort of participants with PsD without a history of cardiovascular events. Traditional cardiovascular risk factors and PsD-related measures of disease activity were considered as potential predictors. The study outcome included nonfatal and fatal cardiovascular events. A base prediction model included 10 traditional cardiovascular risk factors. Eight PsD-related factors were assessed by adding them to the base model to create expanded models, which were controlled for PsD therapies. Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) penalized regression with 10-fold cross-validation. Model performance was assessed using measures of discrimination and calibration and measures of sensitivity and specificity. RESULTS Between 1992 and 2020, 85 of 1,336 participants developed cardiovascular events. Discrimination of the base model (with traditional cardiovascular risk factors alone) was excellent, with an area under the receiver operator characteristic curve (AUC) of 85.5 (95% confidence interval [CI] 81.9-89.1). Optimal models did not select any of the tested disease-specific factors. In a sensitivity analysis, which excluded lipid lowering and antihypertensive treatments, the number of damaged joints was selected in the expanded model. However, this model did not improve risk discrimination compared to the base model (AUC 85.5, 95% CI 82.0-89.1). CONCLUSION Traditional cardiovascular risk factors alone are effective in predicting cardiovascular risk in patients with PsD. A risk score based on these factors performed well, indicating excellent discrimination and calibration.
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Affiliation(s)
- Keith Colaco
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ker-Ai Lee
- University of Waterloo, Waterloo, Ontario, Canada
| | - Shadi Akhtari
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raz Winer
- Rambam Health Care Campus, Haifa, Israel
| | - Vinod Chandran
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Schroeder Arthritis Institute, University Health Network and Depertament of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paula Harvey
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Vincent Piguet
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Schroeder Arthritis Institute, University Health Network and Depertament of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Thomsen RS, Nilsen TIL, Haugeberg G, Sitter B, Kavanaugh A, Pedersen SJ, Hoff M. Changes of inflammation in patients with psoriatic arthritis after high intensity interval training assessed by ultrasound and MRI, a randomized controlled trial. BMC Musculoskelet Disord 2023; 24:743. [PMID: 37726677 PMCID: PMC10508016 DOI: 10.1186/s12891-023-06871-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND In psoriatic arthritis (PsA) there is a theoretical risk of increased disease activity related to strenuous physical activity, including exercise. We evaluated the effect of high intensity interval training (HIIT) on objective measures of inflammation in PsA assessed by ultrasound (US) of peripheral joints and entheses, and by bone marrow edema (BME) on MRI of the sacroiliac joints (SIJ) and spine. METHODS We randomly assigned 67 PsA patients to an intervention group that performed structured HIIT for 11 weeks, or to a control group instructed not to change their physical exercise habits. Outcome measures included US evaluation of the total cohort and MRI in a subgroup of 41; both assessed at 3 months. We calculated the proportions with an increased US B-mode and power-doppler (PD) signal of joints and entheses and Spondyloarthritis-Research-Consortium-of-Canada (SPARCC)-BME score of the SIJ and spine for both groups. RESULTS Proportions with an increased US B-mode score of the joints were 32% and 28% in HIIT and control groups, respectively. Corresponding proportions of PD scores of the joints were 7% and 10% and PD scores of entheses were 32% and 31%. The proportions with increased MRI BME of the SIJ were 6% in the HIIT group and 10% in the control group. Corresponding proportions were 6% and 5% for the MRI BME of the spine. CONCLUSION In PsA patients with a low to moderate disease activity, there was no clear evidence of objectively measured increased inflammation after HIIT, as evaluated by US and MRI. TRIAL REGISTRATION ClinicalTrials.gov NCT02995460 (16/12/2016).
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Affiliation(s)
- Ruth Stoklund Thomsen
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway.
- Department of Circulation and Medical Imaging, NTNU, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Glenn Haugeberg
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway
- Division of Rheumatology, Department of Internal Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Beathe Sitter
- Department of Circulation and Medical Imaging, NTNU, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, School of Medicine, University of California, San Diego, USA
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Disease, Rigshospitalet, Denmark
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Mease PJ, Hatemi G, Paris M, Cheng S, Maes P, Zhang W, Shi R, Flower A, Picard H, Stein Gold L. Apremilast Long-Term Safety Up to 5 Years from 15 Pooled Randomized, Placebo-Controlled Studies of Psoriasis, Psoriatic Arthritis, and Behçet's Syndrome. Am J Clin Dermatol 2023; 24:809-820. [PMID: 37316690 PMCID: PMC10266699 DOI: 10.1007/s40257-023-00783-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Since US FDA approval in 2014, apremilast has consistently demonstrated a favorable benefit-risk profile in 706,585 patients (557,379 patient-years of exposure) worldwide across approved indications of plaque psoriasis, psoriatic arthritis, and Behçet's syndrome; however, long-term exposure across these indications has not been reported. OBJECTIVE The aim of this study was to conduct a pooled analysis of apremilast data from 15 clinical studies with open-label extension phases, focusing on long-term safety. METHODS We analyzed longer-term safety and tolerability of apremilast 30 mg twice daily across three indications for up to 5 years, focusing on adverse events of special interest, including thrombotic events, malignancies, major adverse cardiac events (MACE), serious infections, and depression. Data were pooled across 15 randomized, placebo-controlled studies and divided into placebo-controlled or all-apremilast-exposure groups. Treatment-emergent adverse events (TEAEs) were assessed. RESULTS Overall, 4183 patients were exposed to apremilast (6788 patient-years). Most TEAEs were mild to moderate in the placebo-controlled period (96.6%) and throughout all apremilast exposure (91.6%). TEAE rates of special interest were similar between treatment groups in the placebo-controlled period and remained low throughout all apremilast exposure. Exposure-adjusted incidence rates per 100 patient-years during all apremilast exposure were MACE, 0.30; thrombotic events, 0.10; malignancies, 1.0; serious infections, 1.10; serious opportunistic infections, 0.21; and depression, 1.78. Safety findings were consistent across indications and regions. No new safety signals were identified. CONCLUSIONS The incidence of serious TEAEs and TEAEs of special interest was low despite long-term exposure, further establishing apremilast as a safe oral option for long-term use across indications with a favorable benefit-risk profile. CLINICAL TRIAL REGISTRATION NCT00773734, NCT01194219, NCT01232283, NCT01690299, NCT01988103, NCT02425826, NCT03123471, NCT03721172, NCT01172938, NCT01212757, NCT01212770, NCT01307423, NCT01925768, NCT00866359, NCT02307513.
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Affiliation(s)
- Philip J. Mease
- Swedish Medical Center/Providence St, Joseph Health and University of Washington School of Medicine, Seattle, WA USA
| | - Gülen Hatemi
- School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Atzeni F, La Corte L, Cirillo M, Giallanza M, Galloway J, Rodríguez-Carrio J. Metabolic Syndrome and Its Components Have a Different Presentation and Impact as Cardiovascular Risk Factors in Psoriatic and Rheumatoid Arthritis. J Clin Med 2023; 12:5031. [PMID: 37568433 PMCID: PMC10420311 DOI: 10.3390/jcm12155031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Patients with chronic inflammatory arthritis have a higher cardiovascular (CV) risk than the general population. Traditional CV risk factors are clearly implicated, while the impact of metabolic syndrome (MetS) is less defined. The aim of this study was to compare MetS prevalence and impact on the CV risk in psoriatic arthritis (PsA) versus rheumatoid arthritis (RA). A retrospective analysis of real-world data of PsA and RA patients referred to a rheumatology clinic was conducted. The following data were extracted and compared: demographic data; clinical data; presence of traditional CV risk factors and MetS. Univariate and multivariate models were used to compare the impact of MetS and its components in patients with PsA versus RA. Overall, 170 patients were included (PsA: 78; RA; 92). The two groups differed significantly in mean age, disease duration, and presence of MetS, while other variables were comparable. Univariate and multivariate analysis identified distinct predictors of MetS in PsA (hypertension) and RA (dyslipidemia). The history of CV events was similar in the two groups. Predictors of CV events were MetS and most of its components in PsA, while dyslipidemia was the strongest predictor in RA. These associations were stronger in PsA than in RA. In conclusion, the impact of MetS and its components is different in PsA and RA. The association of these risk factors with CV events is stronger in PsA than in RA. This suggests the implication of different mechanisms, which may require distinct strategies for the prevention of CV events in PsA and RA.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, 98125 Messina, Italy
| | - Laura La Corte
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, 98125 Messina, Italy
| | - Mariateresa Cirillo
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, 98125 Messina, Italy
| | - Manuela Giallanza
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, 98125 Messina, Italy
| | - James Galloway
- Centre for Rheumatic Disease, Kings College London, London WC2R 2LS, UK
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain;
- Instituto de Investigacíon Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
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Madenidou AV, Mavrogeni S, Nikiphorou E. Cardiovascular Disease and Cardiac Imaging in Inflammatory Arthritis. Life (Basel) 2023; 13:life13040909. [PMID: 37109438 PMCID: PMC10143346 DOI: 10.3390/life13040909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
Cardiovascular morbidity and mortality are more prevalent in inflammatory arthritis (IA) compared to the general population. Recognizing the importance of addressing this issue, the European League Against Rheumatism (EULAR) published guidelines on cardiovascular disease (CVD) risk management in IA in 2016, with plans to update going forward based on the latest emerging evidence. Herein we review the latest evidence on cardiovascular disease in IA, taking a focus on rheumatoid arthritis, psoriatic arthritis, and axial spondylarthritis, reflecting on the scale of the problem and imaging modalities to identify disease. Evidence demonstrates that both traditional CVD factors and inflammation contribute to the higher CVD burden. Whereas CVD has decreased with the newer anti-rheumatic treatments currently available, CVD continues to remain an important comorbidity in IA patients calling for prompt screening and management of CVD and related risk factors. Non-invasive cardiovascular imaging has been attracting much attention in view of the possibility of detecting cardiovascular lesions in IA accurately and promptly, even at the pre-clinical stage. We reflect on imaging modalities to screen for CVD in IA and on the important role of rheumatologists and cardiologists working closely together.
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Södergren A, Solbritt Rantapää-Dahlqvist, Ljung L. Time Trends of Cardiovascular Disease in the General Population and Inflammatory Arthritis. Rheum Dis Clin North Am 2023; 49:1-17. [PMID: 36424020 DOI: 10.1016/j.rdc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiovascular diseases (CVDs) are the leading causes of death in the world, but declining trends for cardiovascular (CV) mortality and morbidity have been observed during the last decades. Reports on secular trends regarding the excess CV mortality and morbidity in rheumatoid arthritis show diverging results. Data support that also patients with inflammatory arthritis have benefited from improved treatment and prevention for CVD, which can be observed, for example, in decreased case fatality after CV event. However, several recent studies indicate a remaining excess CV risk in patients with inflammatory arthritis.
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Affiliation(s)
- Anna Södergren
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, 901 87 Umeå, Sweden; Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden.
| | | | - Lotta Ljung
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, 901 87 Umeå, Sweden; Center for Rheumatology, Academic Specialist Center, Stockholm Health Services, Box 6357, Stockholm 102 35, Sweden. https://twitter.com/lotta_ljung
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Felix PAO, Sampaio AL, Silva BL, Viana ALP. Early intervention in psoriasis: Where do we go from here? Front Med (Lausanne) 2022; 9:1027347. [PMID: 36530901 PMCID: PMC9751903 DOI: 10.3389/fmed.2022.1027347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/16/2022] [Indexed: 04/16/2024] Open
Abstract
Patients with psoriasis often have comorbidities and are at increased risk of developing several complications compared with the general population. Knowledge on the role of immune mediators and systemic inflammation in psoriasis has led to the hypothesis that early intervention with systemic therapy has the potential to modify the course of the disease and reduce the risk of long-term adverse outcomes. In this article, we address some potential issues that need to be considered before early intervention can be implemented routinely. The first is determining what constitutes "early" intervention for psoriasis. A second point is whether the intervention should be considered for patients with early disease or for selected subsets based on risk stratification. A third important consideration is defining success for early intervention. Finally, adoption of early and effective intervention should be based on high-level evidence. Ideally, randomized trials would be the best strategy to compare early vs. late systemic treatment in patients with psoriasis, probably using the frequency of long-term outcomes as primary endpoint, with cutaneous and pharmacoeconomic outcomes assessed secondarily.
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Affiliation(s)
| | - Ana Luisa Sampaio
- Dermatology Department, Hospital Universitário Pedro Ernesto, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Melville A. OA12 Dactylitis in PsA: aetiology, clinical significance, & treatment implications. Rheumatol Adv Pract 2022. [PMCID: PMC9515857 DOI: 10.1093/rap/rkac066.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Background
Dactylitis is a hallmark feature of PsA (PsA) and related spondyloarthritides and may affect up to half of PsA patients during the course of their disease(1). Presence of dactylitis may imply a more aggressive disease phenotype; dactylitis at presentation is associated with higher swollen and tender joint counts, higher systemic inflammatory response, presence of ultrasound-detected inflammation and erosions(2), as well as radiographic joint progression(3). Trial data suggest treatments used in PsA may not be equally effective against dactylitis(4).
Description/Method
A 55-year-old man was referred to rheumatology with several months of pain in the right index finger. He was unable to hold a pen, use a computer, or play golf. He had chronic plaque psoriasis since late 20s. On examination, right index finger was mildly swollen, suggestive of dactylitis, and flexion was restricted. No other joints or digits were affected. Inflammatory markers and x-rays of hands and feet were normal. A diagnosis of PsA was made. He had been reviewed by dermatology a few months earlier and started on apremilast; his finger seemed to be improving, so apremilast was continued and etodolac added PRN.
Over the next 2 years he reported short-lived episodes of finger pain but had no objective abnormalities when assessed in clinic. He then developed more persistent left hand pain and stiffness, was felt to have wrist and MCP synovitis, and started on sulfasalazine 1.5g daily, with symptomatic improvement.
Two years later he reported pain in the right hand, with inability to make a fist or play golf. Clinically he had synovitis at the right 4th PIPJ, and soft tissue swelling affecting the 2nd and 3rd fingers. He was given an IM glucocorticoid and sulfasalazine dose was increased to 3g daily. After 3 months he had ongoing difficulty bending the right 4th finger, and mild proximal swelling, and was referred for ultrasound. This showed PIP synovial hypertrophy, an inflamed extensor tendon, marked flexor tenosynovitis, and soft tissue swelling, consistent with dactylitis. He underwent guided injection to the flexor tendon sheath. Four weeks later he reported complete resolution of pain, and 90% improvement in swelling and function. Very recent x-rays of hands and feet showed no visible erosions in the hands, but a large juxta-articular erosion in the right middle toe.
Discussion/Results
This is a case of PsA characterised by isolated finger dactylitis at presentation, and dactylitis as a prominent feature of flare over time.
In general, dactylitis is more common in feet than hands, implicating mechanical stress as a key aetiopathogenetic driver. This patient was a keen golfer, which may explain predominant involvement of his right (dominant) hand 2nd, 3rd and 4th fingers.
While dactylitis is a key disease domain in PsA and other spondyloarthritides, it is not specific to these conditions, and other differentials should be considered depending on specific context, e.g. soft tissue infection or gout. While the diagnosis of PsA seems well-established here, a recent foot x-ray showed a middle toe punched out juxta-articular inter-phalangeal erosion, more typical of gout.
As well as an indicator of arthritis severity and a poor prognostic factor for radiographic progression, the number of dactylitic digits has been shown to be associated with major cardiovascular events, independent of traditional risk factors(5). Presence of dactylitis should perhaps prompt particularly careful assessment of cardiovascular risk.
Recent international (GRAPPA) guidelines give strong recommendations for all targeted therapies commonly used in PsA, including anti-TNF, anti-IL17, anti-IL12/23, anti-IL23, JAKi, and apremilast. NSAIDs, local steroid injections and methotrexate are conditionally recommended “for”, while other csDMARDs are conditionally recommended “against”(4). Whether sulfasalazine is truly less effective in this specific disease domain, or this simply represents a lack of supporting evidence, is debatable. In this case, the combination of apremilast and sulfasalazine was reasonably successful, but further flares might warrant a change in therapy, taking account of the dactylitis history.
In cases of uncertainty, ultrasound can be useful for confirmation of dactylitis(6), and/or differentiating between acute (“hot”) dactylitis and chronic (“cold”) dactylitis. The involvement of multiple structures and soft tissues can be visualised and appreciated.
Key learning points/Conclusion
Dactylitis is a hallmark feature of PsA and may be the sole musculoskeletal manifestation. Mechanical stress appears to be an important factor in aetiopathogenesis. Differentials others than spondyloarthritis should be considered. Presence of dactylitis tends to imply a more aggressive PsA phenotype and may have clinical relevance beyond the joints, including increased cardiovascular risk. Assessment for dactylitis should be performed when evaluating disease activity across psoriatic disease domains, and presence of dactylitis incorporated into decisions about treatment.
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Toussirot E, Gallais-Sérézal I, Aubin F. The cardiometabolic conditions of psoriatic disease. Front Immunol 2022; 13:970371. [PMID: 36159785 PMCID: PMC9492868 DOI: 10.3389/fimmu.2022.970371] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Psoriasis (PsO) and psoriatic arthritis (PsA), together known as psoriatic disease (PsD), are immune-mediated diseases with a chronic and relapsing course that affect the skin, the joints or both. The pathophysiology of PsO is complex and involves abnormal expression of keratinocytes and infiltration of the skin with dendritic cells, macrophages, neutrophils and T lymphocytes. Around 30% of patients with PsO develop arthritis with axial and/or peripheral manifestations. Both PsO and PsA share similar Th1- and Th17-driven inflammation, with increased production of inflammatory cytokines, including TNFα, IFN-γ, IL-17, IL-22, IL-23 in the skin and the synovial membrane. PsD is associated with a high burden of cardiometabolic diseases such as hypertension, diabetes, dyslipidemia, obesity, metabolic syndrome and cardiovascular (CV) complications as compared to the general population. These comorbidities share common immunopathogenic pathways linked to systemic inflammation, and are associated with the extent and severity of the disease. Morever, they can influence treatment outcomes in PsD. In this short review, we summarize the available evidence on the epidemiology, clinical aspects and mechanisms of cardiometabolic conditions in patients with PsD. We also discuss the impact of targeted treatments such as methotrexate and biological agents on these cardiometabolic conditions.
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Affiliation(s)
- Eric Toussirot
- INSERM CIC-1431, Centre d’Investigation Clinique, Pôle Recherche, CHU de Besançon, Besançon, France
- Rhumatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
- Département Universitaire de Thérapeutique, Université de Franche-Comté, 25000 Besançon, France
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- *Correspondence: Eric Toussirot,
| | - Irène Gallais-Sérézal
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- Dermatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
| | - François Aubin
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- Dermatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
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Abstract
Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease with a chronic, progressive course. Various aspects of PsA, including its clinical features, disease course and response to treatment, are influenced by sociodemographic characteristics of the patient. This includes patient sex, the biological attributes associated with being male or female, and gender, a sociocultural construct that comprises attitudes, traits and behaviours associated with being a man or a woman. An understanding of sex- and gender-related differences in PsA, as well as their underlying mechanisms, is therefore important for individualized care. In this narrative review, the influence of sex and gender on PsA manifestation and course, patient function and quality of life, and their association with comorbidities are described. Sex- and gender-related disparities in response to advanced therapies and their potential underlying mechanisms are delineated. Differences in pathophysiological mechanisms between male and female patients including genetics, immune and hormonal mechanisms are discussed. Finally, fertility and pregnancy outcomes in PsA are outlined. By adopting sex and gender lenses, this review is aimed at highlighting key differences between male and female patients with PsA and uncovering mechanisms underlying these differences, ultimately promoting individualized care of men and women with PsA and informing future research in this area.
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Schwartz DM, Parel P, Li H, Sorokin AV, Berg AR, Chen M, Dey A, Hong CG, Playford M, Sylvester M, Teague H, Siegel E, Mehta NN. PET/CT-Based Characterization of 18F-FDG Uptake in Various Tissues Reveals Novel Potential Contributions to Coronary Artery Disease in Psoriatic Arthritis. Front Immunol 2022; 13:909760. [PMID: 35720288 PMCID: PMC9201918 DOI: 10.3389/fimmu.2022.909760] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives Psoriasis is a heterogeneous inflammatory disease that involves the skin, joints, liver, heart, and other organs. Psoriatic arthritis (PsA) is associated with cardiovascular disease (CVD), but the relative contributions of inflammatory and metabolic dysregulation to CVD are incompletely understood. We set out to discover novel potential contributors to CVD in PsA patients by comprehensively phenotyping a cohort of PsA patients using these advanced technologies. Methods In this cross-sectional analysis of a cohort study, we investigated associations of systemic inflammation and metabolic dysregulation with Coronary CT angiography (CCTA)-proven coronary artery disease (CAD) in 39 subjects with PsA. We measured traditional CVD risk factors [blood pressure, Body Mass Index (BMI), diabetes, age, sex, smoking], serum markers of systemic inflammation (hsCRP, GlycA) and metabolic dysfunction (cholesterol efflux capacity), and inflammatory cytokines (IL-1β, IL-6, IL-12/IL-23, IL-17A, TNF-α, IFN-γ). We also incorporated radiographic measures of metabolic dysfunction (visceral and subcutaneous adipose volume) and tissue-specific inflammation (positron emission tomography-computed tomography, PET-CT). To quantify relative contributions of FDG (fluorodeoxyglucose) uptake and adiposity to coronary plaque, we performed multiple linear regression, controlling for Framingham risk score (FRS) and FRS + visceral adiposity. Results Compared with non-psoriatic volunteers, subjects with PsA had elevated markers of metabolic and inflammatory disease, which was more pronounced in subjects with moderate-to-severe skin disease. This included visceral (p = 0.005) and subcutaneous (p = 0.004) adiposity, BMI (p = 0.001), hemoglobin A1C (p = 0.037), high sensitivity C-reactive protein (p = 0.005), IL-6 (p = 0.003), IFN-γ (p = 0.006), and liver FDG uptake (p = 0.03). In subjects with PsA, visceral adiposity correlated significantly with subclinical CAD (standardized β = 0.681, p = 0.002), as did FDG uptake in bone marrow (standardized β = 0.488, p = 0.008), liver (standardized β = 0.619, p < 0.001), spleen (standardized β = 0.523, p = 0.004), and subcutaneous adipose (standardized β = 0.524, p = 0.003). Interpretation Together, these findings reveal inflammatory and metabolic potential contributors to subclinical CAD in PsA, including adipose inflammation, and suggesting novel targets for CVD prevention and treatment in PsA.
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Affiliation(s)
- Daniella M Schwartz
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States.,Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Philip Parel
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Haiou Li
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Alexander V Sorokin
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Alexander R Berg
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Marcus Chen
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Amit Dey
- Department of Internal Medicine, Georgetown University Medical Center, Washington, DC, United States
| | - Christin G Hong
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Martin Playford
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - McKella Sylvester
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Heather Teague
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Evan Siegel
- Arthritis and Rheumatism Associates, Wheaton, MD, United States
| | - Nehal N Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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Mogard E, Bremander A, Haglund E. A combination of two or more unhealthy lifestyle factors is associated with impaired physical and mental health in patients with spondyloarthritis: a cross-sectional study. BMC Rheumatol 2022; 6:29. [PMID: 35610662 PMCID: PMC9131533 DOI: 10.1186/s41927-022-00260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing knowledge of how individual lifestyle factors affect patients with spondyloarthritis, while studies exploring the combination of unhealthy lifestyle factors are lacking. Thus, our aim was to study the frequency of two or more unhealthy lifestyle factors and their associations with physical and mental health in patients with spondyloarthritis (SpA). METHODS A population-based postal survey involving questions on lifestyle factors was completed by 1793 patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and undifferentiated spondyloarthritis (USpA). Self-reported physical activity, body mass index, and tobacco use were respectively dichotomized as "healthy" or "unhealthy", summarized for each patient and stratified into four groups (0-3; 0 = no unhealthy lifestyle factors). Group comparisons were performed with Chi-squared tests, and associations with physical and mental health outcomes were performed with analysis of covariance and logistic regression analysis. RESULTS Out of 1426 patients (52% women) with complete information for all studied lifestyle factors, 43% reported ≥ two unhealthy lifestyle factors-more frequently patients with PsA (48%) than AS (39%) or USpA (38%)-and with no difference between women and men (p = 0.399). Two or more unhealthy lifestyle factors were associated with worse health-related quality of life, disease activity, physical function, pain, fatigue, anxiety, and depression, adjusted for age and SpA-subgroup. If an unhealthy level of physical activity was one of the two unhealthy lifestyle factors, patients reported worse health outcomes. CONCLUSION Reporting two or more unhealthy lifestyle factors were associated with worse physical and mental health in patients with SpA. This highlights the need to screen for a combination of unhealthy lifestyle factors and offer individualized coordinated interventions, and tailored coaching to support behavioral change, in order to promote sustainable health.
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Affiliation(s)
- Elisabeth Mogard
- Department of Clinical Sciences Lund, Rheumatology, Skane University Hospital, Lund University, Lund, Sweden.
| | - Ann Bremander
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, Lund, Sweden.,Spenshult Research and Development Centre, Halmstad, Sweden.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Emma Haglund
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, Lund, Sweden.,Spenshult Research and Development Centre, Halmstad, Sweden.,Rydberg Laboratory of Applied Sciences, Halmstad University, Halmstad, Sweden
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20
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Zheng Z, Guo Q, Ma D, Wang X, Zhang C, Wang H, Zhang L, Zhang G. Related Risk Factors and Treatment Management of Psoriatic Arthritis Complicated With Cardiovascular Disease. Front Cardiovasc Med 2022; 9:835439. [PMID: 35463753 PMCID: PMC9019598 DOI: 10.3389/fcvm.2022.835439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/07/2022] [Indexed: 01/09/2023] Open
Abstract
Psoriatic arthritis (PsA) is a chronic autoimmune inflammatory joint disease related to psoriasis (PsO). The risk of PsA patients with cardiovascular disease (CVD) is significantly higher than that of the general population. At present, the relevant mechanism is not clear, chronic inflammation and traditional cardiovascular risk factors are the most important factors for the increased risk of CVD in PsA patients. Early assessment of the risk of PsA patients with CVD, and active control of the disease activity of PsA patients and intervention of traditional cardiovascular risk factors can delay the progression of CVD risk. This article reviews the epidemiology and pathogenesis between PsA and CVD, and reviews the latest developments in the risk assessment and management of CVD in PsA patients.
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Affiliation(s)
- Zhoulan Zheng
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Qianyu Guo
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Dan Ma
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Xuexue Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Chengqiang Zhang
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Haiyao Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Liyun Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Gailian Zhang
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China
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Kuriya B, Akhtari S, Movahedi M, Udell JA, Lawler PR, Farkouh M, Keystone EC, Hanneman K, Nguyen E, Harvey PJ, Eder L. Statin Use for Primary Cardiovascular Disease Prevention is Low in Inflammatory Arthritis. Can J Cardiol 2022; 38:1244-1252. [DOI: 10.1016/j.cjca.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 12/23/2022] Open
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22
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Colaco K, Lee KA, Akhtari S, Winer R, Welsh P, Sattar N, McInnes IB, Chandran V, Harvey P, Cook RJ, Gladman DD, Piguet V, Eder L. Association of Cardiac Biomarkers With Cardiovascular Outcomes in Patients With Psoriatic Arthritis and Psoriasis: A Longitudinal Cohort Study. Arthritis Rheumatol 2022; 74:1184-1192. [PMID: 35261189 PMCID: PMC9545279 DOI: 10.1002/art.42079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/08/2021] [Accepted: 01/25/2022] [Indexed: 11/20/2022]
Abstract
Objective In patients with psoriatic disease (PsD), we determined whether cardiac troponin I (cTnI) and N‐terminal pro–brain natriuretic peptide (NT‐proBNP) were associated with carotid plaque burden and the development of cardiovascular events independent of the Framingham Risk Score (FRS). Methods Among 1,000 patients with PsD, carotid total plaque area (TPA) was measured in 358 participants at baseline. Cardiac troponin I and NT‐proBNP were measured using automated clinical assays. The association between cardiac biomarkers and carotid atherosclerosis was assessed by multivariable regression after adjusting for cardiovascular risk factors. Improvement in the prediction of cardiovascular events beyond the FRS was tested using measures of risk discrimination and reclassification. Results In univariate analyses, cTnI (β coefficient 0.52 [95% confidence interval (95% CI) 0.3, 0.74], P < 0.001) and NT‐proBNP (β coefficient 0.24 [95% CI 0.1, 0.39], P < 0.001) were associated with TPA. After adjusting for cardiovascular risk factors, the association remained statistically significant for cTnI (adjusted β coefficient 0.21 [95% CI 0, 0.41], P = 0.047) but not for NT‐proBNP (P = 0.21). Among the 1,000 patients with PsD assessed for cardiovascular risk prediction, 64 patients had incident cardiovascular events. When comparing a base model (with the FRS alone) to expanded models (with the FRS plus cardiac biomarkers), there was no improvement in predictive performance. Conclusion In patients with PsD, cTnI may reflect the burden of atherosclerosis, independent of traditional cardiovascular risk factors. Cardiac troponin I and NT‐proBNP are associated with incident cardiovascular events independent of the FRS, but further study of their role in cardiovascular risk stratification is warranted.
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Affiliation(s)
- Keith Colaco
- Women's College Hospital, University of Toronto, and University Health Network, Toronto, Ontario, Canada
| | - Ker-Ai Lee
- University of Waterloo, Waterloo, Ontario, Canada
| | - Shadi Akhtari
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Raz Winer
- Rambam Health Care Campus, Haifa, Israel
| | | | | | | | - Vinod Chandran
- University of Toronto and University Health Network Toronto, Ontario, Canada
| | - Paula Harvey
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Dafna D Gladman
- University of Toronto and University Health Network Toronto, Ontario, Canada
| | - Vincent Piguet
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Lihi Eder
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
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Role of Janus Kinase Inhibitors in Therapy of Psoriasis. J Clin Med 2021; 10:jcm10194307. [PMID: 34640327 PMCID: PMC8509829 DOI: 10.3390/jcm10194307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 12/23/2022] Open
Abstract
Janus kinases inhibitors are molecules that target Janus kinases-signal transducers and activators of transcription (JAK/STAT). They inhibit this intracellular signal pathway, blocking the gene transcription of crucial proinflammatory cytokines that play a central role in the pathogenesis of many inflammatory and autoimmune diseases, including psoriasis. This process reduces psoriatic inflammation. The JAK inhibitors are divided into two generations. The first generation of JAK inhibitors blocks two or more different Janus kinases. The second generation is more specified and blocks only one type of Janus kinase and has less side effects than the first generation. Tofacitinib, ruxolitinib and baricitinib belong to first generation JAK inhibitors and decernotinib and filgotinib belong to second group. This narrative review summarizes the role of Janus kinase inhibitors in the therapy of psoriasis. Oral JAK inhibitors show promise for efficacy and safety in the treatment of psoriasis. Studies to date do not indicate that JAK inhibitors are superior to recent biologic drugs in terms of efficacy. However, JAK inhibitors, due to their lack of increased incidence of side effects compared to other biologic drugs, can be included in the psoriasis treatment algorithm because they are orally taken. Nevertheless, further studies are needed to evaluate long-term treatment effects with these drugs.
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Atzeni F, Gerratana E, Francesco Masala I, Bongiovanni S, Sarzi-Puttini P, Rodríguez-Carrio J. Psoriatic Arthritis and Metabolic Syndrome: Is There a Role for Disease Modifying Anti-Rheumatic Drugs? Front Med (Lausanne) 2021; 8:735150. [PMID: 34527685 PMCID: PMC8435605 DOI: 10.3389/fmed.2021.735150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 01/09/2023] Open
Abstract
Although psoriatic arthritis (PsA) primarily leads to joint and skin damage, it is associated with higher prevalence of metabolic syndrome (MetS) and its components, namely hypertension, dyslipidemia, obesity, and type II diabetes. Additionally, chronic inflammation is known to aggravate these cardiometabolic factors, thus explaining the enhanced cardiovascular (CV) morbidity and mortality in RA. Furthermore, emerging evidence suggest that some risk factors can fuel inflammation, thus pointing to a bidirectional crosstalk between inflammation and cardiometabolic factors. Therefore, dampening inflammation by disease-modifying anti-rheumatic drugs (DMARDs) may be thought to ameliorate MetS burden and thus, CV risk and disease severity. In fact, recommendations for PsA management emphasize the need of considering comorbidities to guide the treatment decision process. However, the existing evidence on the impact of approved DMARDs in PsA on MetS and MetS components is far from being optimal, thus representing a major challenge for the clinical setting. Although a beneficial effect of some DMARDs such as methotrexate, TNF inhibitors and some small molecules is clear, no head-to-head studies are published and no evidence is available for other therapeutic approaches such as IL-23 or IL-17 inhibitors. This narrative review summarizes the main evidence related to the effect of DMARDs on MetS outcomes in PsA patients and identify the main limitations, research needs and future perspectives in this scenario.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy,*Correspondence: Fabiola Atzeni
| | - Elisabetta Gerratana
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | | | - Sara Bongiovanni
- Rheumatology Unit, Azienda Socio Sanitaria Territoriale (ASST)-Fatebenefratelli L. Sacco University Hospital, University of Milan, Milan, Italy
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Azienda Socio Sanitaria Territoriale (ASST)-Fatebenefratelli L. Sacco University Hospital, University of Milan, Milan, Italy
| | - Javier Rodríguez-Carrio
- Department of Functional Biology, Immunology Area, Faculty of Medicine, University of Oviedo, Oviedo, Spain,Area of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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25
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Jamil M, Aslam R, Patel A, Nadir B, Khan S. Prevalence and Extent of Subclinical Atherosclerosis and Associated Cardiovascular Risk Factors in Adult Patients With Psoriatic Arthritis: A Systematic Review. Cureus 2021; 13:e16853. [PMID: 34513433 PMCID: PMC8412334 DOI: 10.7759/cureus.16853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/03/2021] [Indexed: 01/15/2023] Open
Abstract
Psoriatic arthritis (PsA) is a chronic T cell-mediated inflammatory condition affecting a considerable proportion of psoriasis (PSO) patients and a small segment of the general population. Recent studies have shown that patients with PsA are prone to premature atherosclerosis and are at an increased risk of cardiovascular disease (CVD) events, but the extent and prevalence of this are unknown. Our objective was to evaluate the prevalence and extent of subclinical atherosclerosis by measuring the intima-media thickness (IMT) of arteries in adult patients with PsA, as well as identify cardiovascular (CV) risk factors associated with PsA. An extensive literature search was conducted using PubMed as our main database. The articles exploring the association between PsA and subclinical atherosclerosis were included. We also searched other databases like MEDLINE and PubMed Central (PMC). A total of 2,561 studies published between 2005-2021 were obtained by searching the databases, and after the screening process, a total of nine studies were included for review and an additional 22 studies for comparison and backup evidence. As for results, our review included a total of 542 patients with PsA from nine different studies. All the reviewed studies showed a significant association between subclinical atherosclerosis and PsA, as endothelial functions were found to be impaired in PsA patients as deduced by measuring the carotid intima-media thickness (CIMT). PsA patients exhibited greater IMT than healthy controls. Increased IMT independently correlated with parameters of disease activity and conventional risk factors of atherosclerosis. An increased prevalence of CV risk factors such as hypertension, diabetes, obesity, and metabolic syndrome was also found in PsA patients.
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Affiliation(s)
- Maria Jamil
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Reema Aslam
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aanal Patel
- Hepatology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bakhtawar Nadir
- Neurological Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Lam SH, So H, Cheng IT, Li EK, Wong P, Li TK, Lee APW, Tam LS. Association of C-reactive protein and non-steroidal anti-inflammatory drugs with cardiovascular events in patients with psoriatic arthritis: a time-dependent Cox regression analysis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211027712. [PMID: 34262622 PMCID: PMC8252335 DOI: 10.1177/1759720x211027712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 12/23/2022] Open
Abstract
Aims: Psoriatic arthritis (PsA) is associated with accelerated atherosclerosis due to underlying inflammation. Whether inflammatory burden and drugs used to suppress inflammation over time are associated with cardiovascular (CV) events remained unclear. This study aims to examine the time-varying effect of C-reactive protein (CRP) levels and the use of drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) and disease modifying anti-rheumatic drugs, on the risk of CV events independent of traditional CV risk factors in PsA patients. Methods: A retrospective cohort analysis was performed in patients with PsA who were recruited from 2008 to 2015 and followed until the end of 2019. The outcome was occurrence of a first CV event. Framingham risk score (FRS) was used to quantify the traditional CV risk. Cox proportional hazard models with time-varying CRP levels and drugs used were analysed to identify the risk factors for CV events in PsA patients. Results: Two hundred patients with PsA [median age: 47.5 (40.0–56.0); male: 119 (59.5%)] were recruited. After a mean follow-up of 8.8 ± 3.8 years, 30 (15%) patients developed a first CV event. The multivariable Cox regression model showed that time-varying CRP level [hazard ratio (HR) 1.02, 95% confidence interval (CI) 1.00–1.04] and NSAIDs exposure (HR 0.38, 95% CI 0.15–0.96) were significantly associated with CV events after adjusting for baseline FRS (HR 5.06, 95% CI 1.84–13.92). Conclusion: Increased inflammatory burden as reflected by elevated CRP level was associated with increased risk of CV events, while the risk was significantly reduced with NSAIDs use in PsA patients.
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Affiliation(s)
- Steven H Lam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Ho So
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Isaac T Cheng
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Edmund K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Priscilla Wong
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Alex Pui-Wai Lee
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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27
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So H, Tam LS. Cardiovascular disease and depression in psoriatic arthritis: Multidimensional comorbidities requiring multidisciplinary management. Best Pract Res Clin Rheumatol 2021; 35:101689. [DOI: 10.1016/j.berh.2021.101689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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29
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Colaco K, Lee KA, Akhtari S, Winer R, Welsh P, Sattar N, McInnes IB, Chandran V, Harvey P, Cook RJ, Gladman DD, Piguet V, Eder L. Targeted metabolomic profiling and prediction of cardiovascular events: a prospective study of patients with psoriatic arthritis and psoriasis. Ann Rheum Dis 2021; 80:1429-1435. [PMID: 34049856 DOI: 10.1136/annrheumdis-2021-220168] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/19/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE In patients with psoriatic disease (PsD), we sought serum metabolites associated with cardiovascular (CV) events and investigated whether they could improve CV risk prediction beyond traditional risk factors and the Framingham Risk Score (FRS). METHODS Nuclear magnetic resonance metabolomics identified biomarkers for incident CV events in patients with PsD. The association of each metabolite with incident CV events was analysed using Cox proportional hazards regression models first adjusted for age and sex, and subsequently for traditional CV risk factors. Variable selection was performed using penalisation with boosting after adjusting for age and sex, and the FRS. RESULTS Among 977 patients with PsD, 70 patients had incident CV events. In Cox regression models adjusted for CV risk factors, alanine, tyrosine, degree of unsaturation of fatty acids and high-density lipoprotein particles were associated with decreased CV risk. Glycoprotein acetyls, apolipoprotein B and cholesterol remnants were associated with increased CV risk. The age-adjusted and sex-adjusted expanded model with 13 metabolites significantly improved prediction of CV events beyond the model with age and sex alone, with an area under the receiver operator characteristic curve (AUC) of 79.9 versus 72.6, respectively (p=0.02). Compared with the FRS alone (AUC=73.9), the FRS-adjusted expanded model with 11 metabolites (AUC=75.0, p=0.72) did not improve CV risk discrimination. CONCLUSIONS We identify novel metabolites associated with the development of CV events in patients with PsD. Further study of their underlying causal role may clarify important pathways leading to CV events in this population.
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Affiliation(s)
- Keith Colaco
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Ker-Ai Lee
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Shadi Akhtari
- Department of Cardiology, Women's College Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raz Winer
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Paul Welsh
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Vinod Chandran
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paula Harvey
- Department of Cardiology, Women's College Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Dafna D Gladman
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Piguet
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada .,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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30
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The incidence and risk factors for venous thromboembolic events in patients with psoriasis and psoriatic arthritis. Semin Arthritis Rheum 2021; 51:547-552. [PMID: 33895651 DOI: 10.1016/j.semarthrit.2021.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The risk of arterial vascular events is increased in patients with psoriatic disease (PsD), however, limited information exists about the risk of venous thromboembolism (VTE) in these patients. We assessed the incidence and risk factors for VTE in patients with PsD. METHODS A multicentre cohort study was conducted involving patients with PsD followed prospectively from 1994 to 2020. Information about VTE, including pulmonary embolism (PE) and deep venous thrombosis (DVT), was obtained from provincial hospitalization databases. The incidence rate and cumulative probability of developing VTE were computed. Cox proportional hazards models were used to assess the association between risk factors, including comorbidities and disease-related factors, and the first VTE. RESULTS A total 2,433 patients with PsD were analysed with 26 incident VTE (7 DVT alone, 12 PE alone, and 7 both PE and DVT). The incidence rates of the first VTE, DVT, and PE were 12, 6.5, and 8.8 events per 10,000 patient-years, respectively. The cumulative proportion of individuals developing VTE was 4.6% by 80 years of age. Independent predictors for VTE included older age, diabetes mellitus, and corticosteroid usage (all p<0.05). CONCLUSION Older patients with PsD, those with diabetes, and those using corticosteroids are at a higher risk of developing VTE. Risk stratification of patients with these identified risk factors for VTE will allow for more individualized patient management and improved medication selection.
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31
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Karmacharya P, Ogdie A, Eder L. Psoriatic arthritis and the association with cardiometabolic disease: a narrative review. Ther Adv Musculoskelet Dis 2021; 13:1759720X21998279. [PMID: 33737966 PMCID: PMC7934027 DOI: 10.1177/1759720x21998279] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 12/20/2022] Open
Abstract
Psoriatic arthritis (PsA) is associated with a higher burden of cardiometabolic disorders, such as hypertension, dyslipidemia, diabetes, obesity, and cardiovascular disease (CVD), compared with the general population. These comorbidities are associated with the severity of disease, and adversely affect treatment outcomes in PsA. Comorbidities lead to increased physician visits and medications for patients and make the selection and maintenance of therapies challenging for physicians. Moreover, CVD is a leading cause of mortality in PsA. Therefore, optimal management of PsA should include not only treating the skin and joint disease, but also identifying comorbidities early, and managing them to improve long-term outcomes. Further studies are needed to understand the complex mechanisms, interactions, and trajectories of cardiometabolic comorbidities in psoriatic disease.
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Affiliation(s)
| | - Alexis Ogdie
- Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lihi Eder
- Department of Medicine/Rheumatology, Women's College Hospital, University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
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Koppikar S, Colaco K, Harvey P, Akhtari S, Chandran V, Gladman DD, Cook R, Eder L. Incidence of and Risk Factors for Heart Failure in Patients with Psoriatic Disease - A Cohort Study. Arthritis Care Res (Hoboken) 2021; 74:1244-1253. [PMID: 33571391 DOI: 10.1002/acr.24578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 12/02/2020] [Accepted: 02/09/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess the incidence and risk factors for heart failure (HF) in patients with psoriatic disease (PsD) and describe their electrocardiographic and echocardiographic findings. METHODS A cohort analysis was conducted involving patients with PsD followed prospectively from 1978 to 2018. Participants were assessed according to a standard protocol every 6 to 12-months. The primary outcome was the time to first event of HF, further classified into ischemic and non-ischemic HF (secondary outcomes). The association between cardiovascular risk factors, measures of disease activity and HF events was assessed using Cox proportional hazards regression. Electrocardiographic and echocardiographic findings associated with HF events were described. RESULTS A total of 1994 patients with PsD were analyzed with 64 incident HF events (38 ischemic, 26 non-ischemic). The incidence rate of first HF event was 2.85 per 1000 patient years. In all events, most common electrocardiographic findings were atrial fibrillation (22%) and bundle branch blocks (29%). Echocardiogram revealed 37% reduced ejection fraction and 63% preserved ejection fraction. In multivariable analysis, independent risk factors for all HF events were ischemic heart disease, adjusted mean (AM)-tender joint count, AM-swollen joint count, AM-erythrocyte sedimentation rate, AM-C-reactive protein, and physical function (by health assessment questionnaire) (all p<0.05). Minimal disease activity state was protective for all HF (p<0.05). CONCLUSIONS Increased risk of HF is associated with a combination of known cardiovascular risk factors and measures of disease activity, particularly in non-ischemic HF. The effect of inflammation on HF may be partially independent of atherosclerotic disease.
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Affiliation(s)
- Sahil Koppikar
- Division of Rheumatology, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Keith Colaco
- Division of Rheumatology, Women's College Hospital, Toronto, ON, Canada
| | - Paula Harvey
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Women's College Hospital, Toronto, ON, Canada
| | - Shadi Akhtari
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Women's College Hospital, Toronto, ON, Canada
| | - Vinod Chandran
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Dafna D Gladman
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - Lihi Eder
- Division of Rheumatology, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Thomsen RS, Nilsen TIL, Haugeberg G, Gulati AM, Kavanaugh A, Hoff M. Adiposity and Physical Activity as Risk Factors for Developing Psoriatic Arthritis: Longitudinal Data From a Population-Based Study in Norway. Arthritis Care Res (Hoboken) 2021; 73:432-441. [PMID: 31811695 DOI: 10.1002/acr.24121] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/03/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Adiposity is prevalent among patients with psoriatic arthritis (PsA). However, the temporal relation is unclear. The present study was undertaken to investigate whether adiposity and body fat distribution are related to the risk of developing PsA, and whether physical activity could modify the possible risk. METHODS We included 36,626 women and men from the Norwegian Nord-Trøndelag Health Study without diagnosed PsA at baseline from 1995 to 1997. Cox regression analysis was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) of incident PsA at follow-up from 2006 to 2008. RESULTS During follow-up, 185 new cases of PsA were reported. Increases of 1 SD in body mass index (BMI) (4.2 and 3.5 kg/m2 for women and men, respectively) and waist circumference (10.8 and 8.6 cm, respectively) were associated with HRs of 1.40 (95% CI 1.24, 1.58) and 1.48 (95% CI 1.31, 1.68), respectively. Compared to individuals of normal weight, obese individuals had an HR of 2.46 (95% CI 1.65, 3.68), and overweight individuals had an HR of 1.41 (95% CI 1.00, 1.99). Comparing extreme quartiles of waist circumference yielded an HR of 2.63 (95% CI 1.73, 3.99). In analyses of combined effects using a BMI of <25 kg/m2 and high physical activity as reference, a BMI of ≥25 kg/m2 was associated with HRs of 2.06 (95% CI 1.18, 3.58) and 1.53 (95% CI 0.80, 2.91) among those with low and high physical activity levels, respectively. Corresponding HRs for high waist circumference and physical activity were 2.25 (95% CI 1.40, 1.63) and 1.85 (95% CI 0.95, 3.50). CONCLUSION The results suggest that adiposity, particularly central obesity, is associated with increased risk of incident PsA. Although there was no clear modifying effect of physical activity, high levels of physical activity reduced the risk of PsA, regardless of BMI.
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Affiliation(s)
- Ruth S Thomsen
- Norwegian University of Science and Technology and St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tom I L Nilsen
- Norwegian University of Science and Technology and St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Glenn Haugeberg
- Norwegian University of Science and Technology, Trondheim, Norway, and Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Agnete M Gulati
- St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Mari Hoff
- Norwegian University of Science and Technology and St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Kuk M, Ward NC, Dwivedi G. Extrinsic and Intrinsic Responses in the Development and Progression of Atherosclerosis. Heart Lung Circ 2021; 30:807-816. [PMID: 33468387 DOI: 10.1016/j.hlc.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022]
Abstract
Atherosclerosis is a multifactorial disease that is thought to be primarily inflammatory in origin. Given the contribution of inflammation to the development and progression of atherosclerosis, other conditions that are characterised by a dysregulated inflammatory response have also been proposed to play a role. The purpose of this review is to organise and present the various inflammatory processes that can affect atherosclerosis into two broad categories: extrinsic or host-independent and intrinsic or host-dependent. Within these two categories, we will discuss various processes that may contribute to the development and progression of atherosclerosis and the clinical studies describing these associations. Although the clinical trials investigating anti-inflammatory therapies have to date provided mixed results, further studies, particularly in conjunction with lipid-lowering and blood pressure lowering therapies should be considered.
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Affiliation(s)
- Mariya Kuk
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada; McGill University Health Centre, McGill University, Montreal, Canada
| | - Natalie C Ward
- School of Public Health, Curtin University, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia
| | - Girish Dwivedi
- Medical School, University of Western Australia, Perth, WA, Australia; Harry Perkins Institute for Medical Research, Fiona Stanley Hospital, Perth, WA, Australia.
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Cheng IT, Li EK, Wong PC, Law MY, Yim IC, Lai BT, Ying SK, Kwok KY, Li M, Li TK, Lee JJ, Szeto CC, Yan BP, Lee AP, Tam LS. Treat to target and prevention of subclinical atherosclerosis in psoriatic arthritis-which target should we choose? Rheumatology (Oxford) 2020; 59:2881-2892. [PMID: 32087023 DOI: 10.1093/rheumatology/keaa025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/10/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE PsA patients who achieved sustained minimal disease activity (sMDA) had less subclinical atherosclerosis progression. The vascular effects of achieving other potential treatment targets, including the PsA Disease Activity Score (PASDAS) and the Disease Activity in PsA (DAPSA) score, remained uncertain. This study aimed to compare the vascular effects of achieving different treatment targets in PsA patients. METHOD This is a post hoc analysis of a 2 year treat-to-target study aimed at MDA. A total of 101 consecutive PsA patients without overt cardiovascular disease were recruited. High-resolution carotid ultrasound and arterial stiffness markers were assessed annually. Low disease activity (LDA) was defined as MDA, DAPSA ≤14 or PASDAS ≤3.2. Sustained disease control was defined as achieving these targets at each visit from month 12 until month 24. RESULTS Ninety patients [52 male (57.8%), age 50 years (s.d. 11)] who completed 24 months of follow-up were included in this analysis. A total of 44%, 48% and 45% of patients achieved sustained DAPSA LDA (sDAPDA-LDA), sustained PASDAS LDA (sPASDAS-LDA) and sMDA, respectively. Patients who achieved sMDA had significantly less progression of carotid intima-media thickness than those who did not (P = 0.031). Using multivariate analysis, achieving sMDA and sPASDAS-LDA had a protective effect on plaque progression, less increase in total plaque area, reduced mean intima-media thickness and reduced augmentation index after adjusting for covariates. In contrast, no significant differences in the progression of vascular parameters were demonstrated between patients who did or did not achieve sDAPSA-LDA. CONCLUSION Achieving sMDA/sDASPAS-LDA, but not sDAPSA-LDA, was associated with a protective effect in subclinical atherosclerosis and arterial stiffness progression. A multidimensional domain of disease control might be better in minimizing cardiovascular risk in PsA.
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Affiliation(s)
- Isaac T Cheng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Edmund K Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Priscilla C Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Mei Yan Law
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Isaac C Yim
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong
| | - Billy T Lai
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong
| | - Shirley K Ying
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Kitty Y Kwok
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Martin Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jack J Lee
- Division of Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Alex P Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Xie W, Huang H, Xiao S, Yang X, Zhang Z. Effect of statin use on cardiovascular events and all-cause mortality in immune-mediated inflammatory diseases: A systematic review and meta-analysis involving 148,722 participants. Pharmacol Res 2020; 160:105057. [DOI: 10.1016/j.phrs.2020.105057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 02/07/2023]
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Lam SHM, Cheng IT, Li EK, Wong P, Lee J, Yip RML, Yim CW, Ying SK, Li M, Li TK, Lee APW, Tam LS. DAPSA, carotid plaque and cardiovascular events in psoriatic arthritis: a longitudinal study. Ann Rheum Dis 2020; 79:1320-1326. [PMID: 32737113 DOI: 10.1136/annrheumdis-2020-217595] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine whether Disease Activity in Psoriatic Arthritis (DAPSA) reflecting the inflammatory component of psoriatic arthritis (PsA) can predict cardiovascular (CV) events independent of traditional CV risk factors and subclinical carotid atherosclerosis. METHODS A cohort analysis was performed in patients with PsA who had been followed since 2006. The outcome of interest was first CV event. Four different CV disease (CVD) risk scores and DAPSA were computed at baseline. The presence of carotid plaque (CP) and carotid intima-media thickness (CIMT) was also determined in a subgroup of patients using high-resolution ultrasound. The association between DAPSA, CVD risk scores, CP, CIMT and the occurrence of CV events was assessed using Cox proportional hazard models. RESULTS 189 patients with PsA (mean age: 48.9 years; male: 104 (55.0%)) were recruited. After a median follow-up of 9.9 years, 27 (14.3%) patients developed a CV event. Higher DAPSA was significantly associated with an increased risk of developing CV events (HR: 1.04, 95% CI (1.01 to 1.08), p=0.009). The association remained significant after adjusting for all CV risk scores in the multivariable models. In the subgroup analysis, 154 patients underwent carotid ultrasound assessment and 23 (14.9%) of them experienced a CV event. CP was associated with increased risk of developing CV events after adjusting for three CV risk scores and DAPSA, with HR ranging from 2.35 to 3.42. CONCLUSION Higher DAPSA and the presence of CP could independently predict CVD events in addition to traditional CV risk scores in patients with PsA.
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Affiliation(s)
- Steven Ho Man Lam
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Isaac T Cheng
- Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Edmund K Li
- Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Priscilla Wong
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jolie Lee
- Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong, Hong Kong
| | - Ronald Man-Lung Yip
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Cheuk-Wan Yim
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
| | - Shirley K Ying
- Department of Medicine, Princess Margaret Hospital, Hong Kong, China
| | - Martin Li
- Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tena K Li
- Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Alex Pui-Wai Lee
- Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, New Territories, Hong Kong
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Mease PJ, Gladman DD, Gomez-Reino JJ, Hall S, Kavanaugh A, Lespessailles E, Schett G, Paris M, Delev N, Teng L, Wollenhaupt J. Long-Term Safety and Tolerability of Apremilast Versus Placebo in Psoriatic Arthritis: A Pooled Safety Analysis of Three Phase III, Randomized, Controlled Trials. ACR Open Rheumatol 2020; 2:459-470. [PMID: 32710493 PMCID: PMC7437129 DOI: 10.1002/acr2.11156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 03/23/2020] [Indexed: 01/05/2023] Open
Abstract
Objective Psoriatic arthritis (PsA) requires long‐term treatment, yet safety concerns and monitoring requirements make maintenance a challenge. This analysis of pooled Psoriatic Arthritis Long‐term Assessment of Clinical Efficacy (PALACE) 1, 2, and 3 data describes 3‐year apremilast safety and tolerability in PsA. Methods Patients with active PsA were randomized (1:1:1) to placebo, apremilast 30 mg twice daily, or apremilast 20 mg twice daily. Placebo patients were re‐randomized to apremilast 30 mg twice daily or 20 mg twice daily at week 16 (early escape) or 24. Double‐blind treatment continued to week 52; patients could continue apremilast during an open‐label, long‐term treatment phase. Results In total, 1493 patients received at least one dose of study medication and were included in the safety population (placebo: n = 495; apremilast 30 mg: n = 497; apremilast 20 mg: n = 501). Among patients receiving apremilast, 53.2% (767/1441) completed 3 years of treatment. Greater rates of adverse events (AEs) were reported with apremilast (61.1%; exposure‐adjusted incidence rate [EAIR]/100 patient‐years, 265.1) versus placebo (47.5%; EAIR/100 patient‐years, 200.7) in the placebo‐controlled period. During weeks 0 to ≤52, the most common AEs occurring in apremilast‐exposed patients were diarrhea (13.9%; EAIR/100 patient‐years, 18.6), nausea (12.3%; EAIR/100 patient‐years, 16.0), headache (9.4%; EAIR/100 patient‐years, 12.1), upper respiratory tract infection (9.1%; EAIR/100 patient‐years, 11.5), and nasopharyngitis (6.2%; EAIR/100 patient‐years, 7.7). Most AEs were mild/moderate with apremilast exposure ≤156 weeks. Rates of depression remained low (EAIR/100 patient‐years, 1.8). Major adverse cardiac events (EAIR/100 patient‐years, 0.5), malignancies (EAIR/100 patient‐years, 0.9), and serious opportunistic infections (EAIR/100 patient‐years, 0.0) were infrequent over the 3‐year exposure period. Discontinuation rates due to AEs were low (<7.5%) across all apremilast‐exposure periods. Incidences of clinically meaningful abnormalities in postbaseline laboratory values was low; most values returned to baseline levels with continued treatment and without intervention. Conclusion Apremilast demonstrated a favorable safety profile and was well tolerated up to 156 weeks.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, Washington and University of Washington School of Medicine, Seattle
| | - Dafna D Gladman
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Stephen Hall
- Monash University, Cabrini Health, Melbourne, Australia
| | | | | | - Georg Schett
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany und Universitätsklinikum Erlangen, Erlangen, Germany
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Ogdie A, Eder L. The need for strategies to address obesity and psoriatic arthritis prevention in psoriasis. Br J Dermatol 2020; 182:523-524. [PMID: 32107778 DOI: 10.1111/bjd.18595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - L Eder
- Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Kerschbaumer A, Smolen JS, Dougados M, de Wit M, Primdahl J, McInnes I, van der Heijde D, Baraliakos X, Falzon L, Gossec L. Pharmacological treatment of psoriatic arthritis: a systematic literature research for the 2019 update of the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis 2020; 79:778-786. [DOI: 10.1136/annrheumdis-2020-217163] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023]
Abstract
ObjectiveTo perform an update of a review of the efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) in psoriatic arthritis (PsA).MethodsThis is a systematic literature research of 2015–2018 publications on all DMARDs in patients with PsA, searching Medline, Embase and the Cochrane Library. Efficacy was assessed in randomised controlled trials. For safety, cohort studies, case–control studies and long-term extensions (LTEs) were analysed.Results56 publications (efficacy: n=33; safety n=23) were analysed. The articles were on tumour necrosis factor (TNF) inhibitors (n=6; golimumab, etanercept and biosimilars), interleukin (IL)-17A inhibitors (n=10; ixekizumab, secukinumab), IL-23-p19 inhibitors (n=2; guselkumab, risankizumab), clazakizumab (IL-6 inhibitor), abatacept (CD80/86 inhibitor) and ABT-122 (anti-TNF/IL-17A), respectively. One study compared ustekinumab (IL-12/23i) with TNF inhibitor therapy in patients with entheseal disease. Three articles investigated DMARD tapering. Trials on targeted synthetic DMARDs investigated apremilast (phosphodiesterase-4 inhibitor) and Janus kinase inhibitors (JAKi; tofacitinib, filgotinib). Biosimilar comparison with bio-originator showed non-inferiority. Safety was evaluated in 13 LTEs, 9 cohort studies and 1 case–control study investigating malignancies, infections, infusion reactions, multiple sclerosis and major cardiovascular events, as well as efficacy and safety of vaccination. No new safety signals were identified; however, warnings on the risk of venous thromboembolic events including pulmonary embolism when using JAKi were issued by regulators based on other studies.ConclusionMany drugs in PsA are available and have demonstrated efficacy against placebo. Efficacy varies across PsA manifestations. Safety must also be taken into account. This review informed the development of the European League Against Rheumatism 2019 updated PsA management recommendations.
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Gladman DD, Charles-Schoeman C, McInnes IB, Veale DJ, Thiers B, Nurmohamed M, Graham D, Wang C, Jones T, Wolk R, DeMasi R. Changes in Lipid Levels and Incidence of Cardiovascular Events Following Tofacitinib Treatment in Patients With Psoriatic Arthritis: A Pooled Analysis Across Phase III and Long-Term Extension Studies. Arthritis Care Res (Hoboken) 2020; 71:1387-1395. [PMID: 31112005 PMCID: PMC6764856 DOI: 10.1002/acr.23930] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/14/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The risk of cardiovascular disease (CVD) is higher in patients with psoriatic arthritis (PsA) compared to the general population. Tofacitinib is an oral Janus kinase inhibitor for the treatment of PsA. Because tofacitinib increases circulating lipid levels in some patients, we evaluated CVD risk factors and major adverse cardiovascular events (MACE) in patients with active PsA receiving tofacitinib 5 or 10 mg twice daily plus conventional synthetic disease-modifying antirheumatic drugs. METHODS Data were pooled from 2 phase III studies (Efficacy and Safety of Tofacitinib in Psoriatic Arthritis [OPAL Broaden] and Tofacitinib in Patients with Psoriatic Arthritis With Inadequate Response to TNF Inhibitors [OPAL Beyond]) and 1 ongoing long-term extension (Open-Label Extension Study of Tofacitinib in Psoriatic Arthritis [OPAL Balance], data cutoff January 2017; database not locked). Outcomes included fasting lipid levels, blood pressure, hypertension-related adverse events (AEs; including hypertension, high blood pressure, and increased blood pressure), and MACE. RESULTS Overall, 783 tofacitinib-treated patients were included. Percentage increases from baseline in low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) levels ranged from 9% to 14% for tofacitinib 5 mg and 10 mg at 3 and 6 months; no meaningful changes in LDL-c:HDL-c or total cholesterol:HDL-c ratios were observed. Blood pressure remained stable for 24 months. Fifty-eight patients (7.4%) had hypertension-related AEs; none were fatal (incidence rate [IR] per 100 patient-years 4.81 [95% confidence interval (95% CI) 3.65-6.22]). Five patients (0.6%) had MACE (IR 0.24 [95% CI 0.05-0.70]); 2 were fatal. CONCLUSION Serum lipid level increases at month 3 following tofacitinib treatment in PsA were consistent with observations in rheumatoid arthritis and psoriasis. The IR of hypertension-related AEs and MACE was low; long-term follow-up is ongoing.
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Affiliation(s)
- Dafna D Gladman
- University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | | | | | - Douglas J Veale
- St. Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Bruce Thiers
- Medical University of South Carolina, Charleston
| | - Mike Nurmohamed
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, and Reade, Amsterdam, The Netherlands
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Caso F, Chimenti MS, Navarini L, Ruscitti P, Peluso R, Girolimetto N, Del Puente A, Giacomelli R, Scarpa R, Costa L. Metabolic Syndrome and psoriatic arthritis: considerations for the clinician. Expert Rev Clin Immunol 2020; 16:409-420. [PMID: 32149545 DOI: 10.1080/1744666x.2020.1740593] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Metabolic Syndrome (MetS) is strictly interconnected with systemic inflammation, and increased evidence has described a close link between this condition and Psoriatic Arthritis (PsA).Areas covered: This review summarizes main studies exploring clinical aspects and prevalence of MetS in PsA cohorts. Further, there is accumulating evidence showing shared inflammatory pathways between MetS, its components, and PsA.Expert opinion: The high prevalence of MetS in PsA highlights the need for screening, evaluation, and close monitoring of MetS and its components (namely, diabetes mellitus, obesity, hypertension, and dyslipidemia) in psoriatic patients.Further studies should focus on the pathogenetic link between MetS and PsA. More studies are required to identify appropriate algorithms for the assessment and management of MetS in PsA patients.
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Affiliation(s)
- Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosario Peluso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Nicolò Girolimetto
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.,Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Del Puente
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
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Perez-Chada LM, Merola JF. Comorbidities associated with psoriatic arthritis: Review and update. Clin Immunol 2020; 214:108397. [PMID: 32229290 DOI: 10.1016/j.clim.2020.108397] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 02/07/2023]
Abstract
Psoriatic arthritis is an inflammatory arthropathy frequently associated with psoriasis and several other comorbidities. The goal of this review is to summarize the available evidence on the epidemiology, clinical implications, pathological mechanisms proposed, and screening and management recommendations for the comorbidities related with PsA. Reported comorbidities include cardiovascular disease, metabolic syndrome, obesity, diabetes mellitus, dyslipidemia, inflammatory bowel disease, fatty liver disease, uveitis, kidney disease, infections, osteoporosis, depression, central sensitization syndrome, and gout. Given that these comorbidities may affect both clinical outcomes and the management for these patients, their recognition and monitoring by all health-care providers caring for patients with psoriatic arthritis is of utmost importance.
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Affiliation(s)
- Lourdes M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Lo Gullo A, Rodríguez-Carrio J, Gallizzi R, Imbalzano E, Squadrito G, Mandraffino G. Speckle tracking echocardiography as a new diagnostic tool for an assessment of cardiovascular disease in rheumatic patients. Prog Cardiovasc Dis 2020; 63:327-340. [PMID: 32201285 DOI: 10.1016/j.pcad.2020.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 12/30/2022]
Abstract
Chronic inflammation represents the cornerstone of the raised cardiovascular (CV) risk in patients with inflammatory rheumatic diseases (IRD). Standardized mortality ratios are increased in these patients compared to the general population, which can be explained by premature mortality associated with early atherosclerotic events. Thus, IRD patients need appropriate CV risk management in view of this CV disease (CVD) burden. Currently, optimal CV risk management is still lacking in usual care, and early diagnosis of silent and subclinical CVD involvement is mandatory to improve the long-term prognosis of those patients. Although CV involvement in such patients is highly heterogeneous and may affect various structures of the heart, it can now be diagnosed earlier and promptly treated. CV imaging provides valuable information as a reliable diagnostic tool. Currently, different techniques are employed to evaluate CV risk, including transthoracic or trans-esophageal echocardiography, magnetic resonance imaging, or computed tomography, to investigate valve abnormalities, pericardial disease, and ventricular wall motion defects. All the above methods are reliable in investigating CV involvement, but more recently, Speckle Tracking Echocardiography (STE) has been suggested to be diagnostically more accurate. In recent years, the role of left ventricular ejection fraction (LVEF) as the gold standard parameter for the evaluation of systolic function has been debated, and many efforts have been focused on the clinical validation of new non-invasive tools for the study of myocardial contractility as well as to characterize the subclinical alterations of the myocardial function. Improvement in the accuracy of STE has resulted in a large amount of research showing the ability of STE to overcome LVEF limitations in the majority of primary and secondary heart diseases. This review summarizes the additional value that STE measurement can provide in the setting of IRD, with a focus in the different clinical stages.
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Affiliation(s)
- Alberto Lo Gullo
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy; IRCCS Neurolesi Bonino-Pulejo, Piemonte Hospital, 98100, Italy
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Faculty of Medicine, University of Oviedo, Oviedo 33006, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Oviedo 33011, Spain; Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación Nefrológica, REDinREN Del ISCIII, Hospital Universitario Central de Asturias, Oviedo 33011, Spain.
| | - Romina Gallizzi
- Unit of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, 98122
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
| | - Giuseppe Mandraffino
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
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Szentpetery A, Haroon M, FitzGerald O. Cardiovascular Comorbidities in Psoriatic Disease. Rheumatol Ther 2020; 7:5-17. [PMID: 31813119 PMCID: PMC7021890 DOI: 10.1007/s40744-019-00185-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Indexed: 02/06/2023] Open
Abstract
Psoriatic disease (PsD) is a multisystem inflammatory disorder with a high prevalence of cardiovascular (CV) risk factors contributing to accelerated atherosclerosis and its sequelae. Imaging studies, notably with ultrasound, computed tomography, and positron emission tomography (PET) scanning have confirmed significant atherosclerotic change with plaque formation and vessel stenosis. Atherosclerosis is likely driven by a combination of traditional risk factors which occur more frequently in PsD and by systemic inflammation with associated pro-inflammatory cytokine production. While the mechanisms driving atherosclerosis in PsD are incompletely understood, it is now best practice to try to minimize the impact of CV risk factors by regular assessment, prevention, and treatment and also by ensuring that inflammatory musculoskeletal and cutaneous disease is adequately suppressed. Future studies need to focus on improving our understanding of the mechanisms driving atherosclerosis and, as a consequence, developing more rationale approaches to prevention and treatment.
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Affiliation(s)
- Agnes Szentpetery
- Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden
| | - Muhammad Haroon
- Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland.
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Packer M. Epicardial Adipose Tissue Inflammation Can Cause the Distinctive Pattern of Cardiovascular Disorders Seen in Psoriasis. Am J Med 2020; 133:267-272. [PMID: 31520623 DOI: 10.1016/j.amjmed.2019.08.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 12/20/2022]
Abstract
Psoriasis is a systemic inflammatory disorder that can target adipose tissue; the resulting adipocyte dysfunction is manifest clinically as the metabolic syndrome, which is present in ≈20%-40% of patients. Epicardial adipose tissue inflammation is likely responsible for a distinctive pattern of cardiovascular disorders consisting of 1) accelerated coronary atherosclerosis leading to myocardial infarction, 2) atrial myopathy leading to atrial fibrillation and thromboembolic stroke, and 3) ventricular myopathy leading to heart failure with a preserved ejection fraction. If cardiovascular inflammation drives these risks, then treatments that focus on blood pressure, lipids, and glucose will not ameliorate the burden of cardiovascular disease in patients with psoriasis, especially in those who are young and have severe inflammation. Instead, interventions that alleviate systemic and adipose tissue inflammation may not only minimize the risks of atrial fibrillation and heart failure but may also have favorable effects on the severity of psoriasis. Viewed from this perspective, the known link between psoriasis and cardiovascular disease is not related to the influence of the individual diagnostic components of the metabolic syndrome.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Tex; Imperial College, London.
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Navarini L, Sperti M, Currado D, Costa L, Deriu MA, Margiotta DPE, Tasso M, Scarpa R, Afeltra A, Caso F. A machine-learning approach to cardiovascular risk prediction in psoriatic arthritis. Rheumatology (Oxford) 2020; 59:1767-1769. [DOI: 10.1093/rheumatology/kez677] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2019] [Indexed: 01/06/2023] Open
Affiliation(s)
- Luca Navarini
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Roma
| | - Michela Sperti
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Damiano Currado
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Roma
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Naples, Italy
| | - Marco A Deriu
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | | | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Naples, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Naples, Italy
| | - Antonella Afeltra
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Roma
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Naples, Italy
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Ferraz-Amaro I, Hernández-Hernández MV, Armas-González E, Sánchez-Pérez H, Machado JD, Díaz-González F. HDL cholesterol efflux capacity is related to disease activity in psoriatic arthritis patients. Clin Rheumatol 2020; 39:1871-1880. [PMID: 31993889 DOI: 10.1007/s10067-020-04961-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Cholesterol efflux capacity (CEC) is the ability of high-density lipoprotein (HDL) cholesterol to accept cholesterol from macrophages. CEC is linked to cardiovascular events in the general population, and it has been shown to be disrupted in inflammatory states. The aim of this study was to establish whether CEC is impaired in PsA patients and if this could be explained by disease-related features like disease activity. METHODS Case-control study that encompassed 105 individuals: 52 PsA patients and 53 controls. CEC, using an in vitro assay, and lipoprotein serum concentrations were assessed in patients and controls. Disease activity in patients with PsA was measured using the Disease Activity Index for Psoriatic Arthritis (DAPSA). Multivariate analysis was performed to study the differences between CEC in patients and controls, and the relation of CEC with PsA activity-related data and lipid profile. RESULTS Total cholesterol, apolipoprotein A1, and LDL cholesterol serum levels were downregulated in PsA patients. CEC did not differ between controls and patients (17 ± 10 vs. 18 ± 2%, p = 0.15) after adjusting for traditional cardiovascular risk factors or other variations in the lipid profile related to the disease. Traditional cardiovascular risk factors, both in patients and controls, were not related to CEC. After multivariate regression analysis, the DAPSA score was inversely and independently associated with CEC (beta coefficient - 0.75 [95%CI - 1.39-- 0.11] %, p = 0.023). CONCLUSION CEC is inversely associated with disease activity in PSA patients, reinforcing the role of disease activity as a key factor in the development of accelerated atherosclerosis in these patients.Key Points• Cholesterol efflux capacity is linked to cardiovascular events in the general population.• In patients with psoriatic arthritis, cholesterol efflux capacity is inversely associated with disease activity (beta coefficient - 0.75[95% CI - 1.39-- 0.11] %, p = 0.023).• This finding reinforces the role of disease activity as a key factor in increasing cardiovascular risk in psoriatic arthritis patients.
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Affiliation(s)
- Iván Ferraz-Amaro
- Servicio de Reumatología, Hospital Universitario de Canarias, La Laguna, Spain
| | | | | | | | - José David Machado
- Departamento de Farmacología, Facultad de Medicina, Universidad de La Laguna, La Laguna, Spain
| | - Federico Díaz-González
- Servicio de Reumatología, Hospital Universitario de Canarias, La Laguna, Spain. .,Departamento de Medicina Interna, Dermatología y Psiquiatría, Facultad de Medicina, Universidad de La Laguna, La Laguna, Spain. .,Division of Rheumatology, Hospital Universitario de Canarias, 38320, Santa Cruz de Tenerife, Spain.
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Xie W, Xiao S, Huang Y, Sun X, Zhang Z. Effect of tofacitinib on cardiovascular events and all-cause mortality in patients with immune-mediated inflammatory diseases: a systematic review and meta-analysis of randomized controlled trials. Ther Adv Musculoskelet Dis 2019; 11:1759720X19895492. [PMID: 31897092 PMCID: PMC6918042 DOI: 10.1177/1759720x19895492] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background We aimed to systematically assess a possible association of tofacitinib therapy with cardiovascular events (CVEs) and all-cause mortality. Methods Systematic searches of PubMed, Embase, and Cochrane Library were conducted from inception through March 2019. Randomized controlled trials in patients with immune-mediated inflammatory diseases (IMIDs) reporting safety data were included. Included studies compared tofacitinib with placebo or 5 mg tofacitinib with 10 mg tofacitinib. The primary and secondary outcome measures were all CVEs [major adverse cardiovascular events (MACEs)/venous thromboembolism events (VTEs)] and all-cause mortality. Results 29 studies randomizing 13,611 patients were included. Compared with placebo, there was no significant increased risk of all CVEs (OR = 1.07, 95% CI 0.49-2.34), MACEs (OR 1.54, 95% CI 0.42-5.59), or all-cause mortality (OR = 1.13, 95% CI 0.26-4.95), but a decreased rate of VTEs (OR 0.03, 95% CI 0.00-0.21) in patients with IMIDs initiating tofacitinib. Meanwhile, paired comparison showed 10 mg tofacitinib twice daily was associated with a significantly lower incidence of all CVEs (OR = 0.56, 95% CI 0.33-0.96), MACEs (OR = 0.48, 95% CI 0.22-1.05), or all-cause mortality (OR = 0.47, 95% CI 0.19-1.17), but a trend toward an increase in VTEs risk (OR = 1.47, 95% CI 0.25-8.50), compared with the 5 mg regimen. Conclusion Compared with placebo, there was no augmented risk of CVEs and all-cause mortality in patients with IMIDs following tofacitinib treatment in a short-term perspective, whereas 10 mg twice daily tofacitinib appeared to be associated with reduction in cardiovascular and all-cause mortality risks, except VTEs, relative to the 5 mg twice daily dose. Long-term studies and postmarketing risk monitoring are increasingly needed to develop a better understanding.
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Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China
| | - Shiyu Xiao
- Department of Gastroenterology, Peking University Third Hospital, Haidian District, Beijing, China
| | - Yanrong Huang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China
| | - Xiaoying Sun
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China
| | - Zhuoli Zhang
- Director of Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China
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50
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Landgren AJ, Bilberg A, Eliasson B, Larsson I, Dehlin M, Jacobsson LTH, Klingberg E. Cardiovascular risk factors are highly overrepresented in Swedish patients with psoriatic arthritis compared with the general population. Scand J Rheumatol 2019; 49:195-199. [DOI: 10.1080/03009742.2019.1672783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- AJ Landgren
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - B Eliasson
- Department of Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - I Larsson
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Dehlin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - LTH Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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