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Kaleta K, Krupa J, Suchy W, Sopel A, Korkosz M, Nowakowski J. Endothelial dysfunction and risk factors for atherosclerosis in psoriatic arthritis: overview and comparison with rheumatoid arthritis. Rheumatol Int 2024; 44:1587-1606. [PMID: 38522049 PMCID: PMC11343792 DOI: 10.1007/s00296-024-05556-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/05/2024] [Indexed: 03/25/2024]
Abstract
Endothelial dysfunction (ED) is defined as an impairment in the vasodilatory, anti-thrombotic, and anti-inflammatory properties of the cells that make up the lining of blood vessels. ED is considered a key step in the development of atherosclerotic cardiovascular disease. The association between ED and systemic inflammatory diseases is well established. However, the prevalence and clinical significance of ED in psoriatic arthritis (PsA) have been investigated to a lesser extent. This review aims to explore the link between ED and PsA, including ED in macro- and microcirculation, as well as risk factors for its occurrence in PsA and its relationship with atherosclerosis in PsA. Furthermore, the ED in PsA was compared with that of rheumatoid arthritis (RA). Regarding ED in the microcirculation, the coronary flow reserve was found to be significantly reduced in individuals with PsA. The relationship between PsA and macrovascular ED is more pronounced, along with more advanced atherosclerosis detected in patients with PsA. These results are consistent with those obtained in RA studies. On the other hand, arterial stiffness and signs of vascular remodeling were found more frequently in RA than in PsA, with the potential role of efficient anti-TNF treatment in patients with PsA and psoriasis explaining this finding. The impact of ED on cardiovascular diseases and the burden of this risk caused independently by PsA have not yet been precisely established, however, this group of patients requires special attention with regard to cardiovascular events.
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Affiliation(s)
- Konrad Kaleta
- Students' Scientific Group at the Department of Rheumatology and Immunology, Jagiellonian University Medical College, Kraków, Poland
| | - Julia Krupa
- Students' Scientific Group at the Department of Rheumatology and Immunology, Jagiellonian University Medical College, Kraków, Poland
| | - Wiktoria Suchy
- Students' Scientific Group at the Department of Rheumatology and Immunology, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Sopel
- Students' Scientific Group at the Department of Rheumatology and Immunology, Jagiellonian University Medical College, Kraków, Poland
| | - Mariusz Korkosz
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Kraków, Poland
| | - Jarosław Nowakowski
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Kraków, Poland.
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Triantafyllias K, Liverakos S, Muthuraman M, Cavagna L, Parodis I, Schwarting A. Cardiovascular Risk Evaluation in Psoriatic Arthritis by Aortic Stiffness and the Systemic Coronary Risk Evaluation (SCORE): Results of the Prospective PSOCARD Cohort Study. Rheumatol Ther 2024; 11:897-911. [PMID: 38819779 PMCID: PMC11265042 DOI: 10.1007/s40744-024-00676-z] [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: 02/08/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is associated with increased cardiovascular (CV) risk and mortality. Aortic stiffness measured by carotid-femoral pulse wave velocity (cfPWV) has been shown to predict CV risk in the general population. The present study aimed to examine cfPWV values of patients with PsA compared to healthy controls and to evaluate associations of cfPWV with patient- and disease-associated characteristics, as well as with an established traditional CV prediction score of the European Society of Cardiology (Systemic Coronary Risk Evaluation; SCORE), for the first time. METHODS cfPWV and SCORE were evaluated in patients with PsA and healthy controls, along with clinical and laboratory disease parameters. Differences in cfPWV measurements between the two groups and associations of cfPWV with patient- and disease-associated characteristics were statistically evaluated. RESULTS A total of 150 patients with PsA (PSOCARD cohort) and 88 control subjects were recruited. cfPWV was significantly higher in the PsA group compared to controls, even after adjustment for confounders (padj = 0.034). Moreover, cfPWV was independently associated with disease duration (r = 0.304, p = 0.001), age (rho = 0.688, p < 0.001), systolic arterial pressure (rho = 0.351, p < 0.001), glomerular filtration rate (inverse: rho = - 0.264, p = 0.001), and red cell distribution width, a marker of major adverse CV events (MACE) (rho = 0.190, p = 0.02). SCORE revealed an elevated CV risk in 8.73% of the patients, whereas cfPWV showed increased aortic stiffness and end-organ disease in 16.00% of the same cohort. CONCLUSIONS In the largest cfPWV/PsA cohort examined to date, patients with PsA exhibited increased aortic stiffness compared to healthy controls. PsA duration was the most important independent disease-associated predictor of increased aortic stiffness, next to traditional CV risk factors. cfPWV measurements may help identify subclinical end-organ disease and abnormal aortic stiffness and thus assist CV risk classification in PsA.
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Affiliation(s)
- Konstantinos Triantafyllias
- Rheumatology Center Rhineland-Palatinate, Bad Kreuznach, Germany
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | | | | | - Lorenzo Cavagna
- University and IRCCS Policlinic S. Matteo Foundation, Pavia, Italy
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Andreas Schwarting
- Rheumatology Center Rhineland-Palatinate, Bad Kreuznach, Germany.
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
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Kleinrensink NJ, Spierings J, Vonkeman HE, Seddiqi N, Herman A, Suijkerbuijk KPM, Heijstek MW, Jansen MP, de Jong PA, Foppen W. Increased vascular inflammation on PET/CT in psoriatic arthritis patients in comparison with controls. RMD Open 2024; 10:e003547. [PMID: 38296307 PMCID: PMC10836343 DOI: 10.1136/rmdopen-2023-003547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/05/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Patients with psoriatic arthritis (PsA) have an increased risk of cardiovascular disease, possibly due to a chronic inflammatory state. OBJECTIVES The main objective of this study was to investigate the difference in vascular inflammation, measured with 18-fluorodeoxyglucose positron emission tomography/CT (PET/CT), in PsA patients and controls. We conducted a secondary analysis to assess the association between clinical parameters of disease activity with vascular inflammation in PsA. METHODS We included a total of 75 PsA patients with active peripheral arthritis (defined as ≥2 tender and swollen joints) from an ongoing clinical trial (EudraCT 2017-003900-28) and a retrospective group of 40 controls diagnosed with melanoma, without distant metastases and not receiving immunotherapy. The main outcome measure was aortic vascular inflammation which was measured on PET/CT scans using target-to-background ratios. Clinical disease activity in PsA was assessed with joint counts, body surface area and the Disease Activity index for PsA. Laboratory assessments included C reactive protein and erythrocyte sedimentation rate. RESULTS Vascular inflammation was increased in patients with PsA in comparison with controls (mean target-to-background ratio for entire aorta, respectively, 1.63±0.17 vs 1.49±0.16; p=<0.001). This association remained significant after correction for gender, age, body mass index, mean arterial pressure and aortic calcification (p=0.002). Vascular inflammation was not associated with disease-related parameters. CONCLUSIONS Aortic vascular inflammation was significantly increased in patients with active PsA compared with controls. This evidence supports the theory that inflammation in PsA is not limited to the skin and joints but also involves the vascular system.
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Affiliation(s)
- Nienke J Kleinrensink
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Julia Spierings
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Negina Seddiqi
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Amin Herman
- Department of Rheumatology, Sint Antonius Hospital, Nieuwegein, Netherlands
| | | | - Marloes W Heijstek
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Pim A de Jong
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Wouter Foppen
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
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Soysal Gündüz Ö, Armağan Alptürker K, Güler Şen M, Can F, Erdal S, Ulman C, Pırıldar T. The Relationship of Carotid Intima-Media Thickness with Cell Adhesion
Molecules and Pentraxin-3 in Patients with Psoriatic Arthritis. AKTUEL RHEUMATOL 2023. [DOI: 10.1055/a-1942-6311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Abstract
Aim Cardiovascular morbidity is increased in patients with psoriatic
arthritis (PsA) compared to the general population. Several recent studies have
indicated that pentraxin 3 (PTX-3) and cell adhesion molecules (CAMs) might be
independent biomarkers of subclinical atherosclerosis. In this study, we aimed
to determine the relationship of CAMs and PTX-3 with carotid intima media
thickness (CIMT) in patients with PsA and to compare CIMT and serum levels of
these biomarkers in patients with healthy controls (HCs).
Method PsA patients fulfilling the CASPAR (Classification criteria for
Psoriatic Arthritis) criteria without traditional cardiovascular (CV)
comorbidity and HCs without autoimmune and/or CV disease were included
in this cross-sectional study. Carotid artery Doppler ultrasound examinations
were conducted by a single radiologist blinded to the participants’
clinical characteristics. Serum vascular adhesion molecule 1 (VCAM-1),
intercellular adhesion molecule 1 (ICAM-1), E-selectin, and PTX-3 concentrations
were analized.
Results 43 PsA patients (27 females, mean age 42.49±11.70 years,
and a mean disease duration of 9.37±7.96 years) and 37 HCs (28 females,
mean age 42.16±11.38 years) were included. In regression analyses, age
and PTX-3 were found to be the best predictors of CIMT in patients with PsA.
CIMT was significantly higher in PsA patients compared with HCs
(0.63±0.18 vs. 0.49±0.10 mm, p<0.01). In te PsA
group, serum levels of PTX-3, ICAM-1, and VCAM-1 were also significantly higher
than HCs. CIMT correlated positively with age, disease duration, PTX-3, ICAM-1,
and VCAM-1 (p<0.05).
Conclusion In our study, age and serum level of PTX-3 were found to be the
predictors of CIMT in patients with PsA without CV comorbidity. This outcome
highlights the importance of monitoring CIMT and serum level of PTX-3 as CV risk
factors in PsA patients.
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Affiliation(s)
- Özgü Soysal Gündüz
- Faculty of Medicine, Department of Internal Medicine, Division of
Rheumatology, Manisa Celal Bayar University, Manisa, Turkey
| | - Kezban Armağan Alptürker
- Faculty of Medicine, Department of Physical Medicine and
Rehabilitation, Division of Rheumatology, Manisa Celal Bayar University, Manisa,
Turkey
| | - Menice Güler Şen
- Faculty of Medicine, Department of Internal Medicine, Division of
Rheumatology, Manisa Celal Bayar University, Manisa, Turkey
| | - Fatma Can
- Faculty of Medicine, Department of Radiology, Manisa Celal Bayar
University, Manisa, Turkey
| | - Serkan Erdal
- Faculty of Medicine, Department of Medical Biochemistry, Manisa Celal
Bayar University, Manisa, Turkey
| | - Cevval Ulman
- Faculty of Medicine, Department of Medical Biochemistry, Manisa Celal
Bayar University, Manisa, Turkey
| | - Timur Pırıldar
- Faculty of Medicine, Department of Internal Medicine, Division of
Rheumatology, Manisa Celal Bayar University, Manisa, Turkey
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Ambrosino P, Sanduzzi Zamparelli S, Mosella M, Formisano R, Molino A, Spedicato GA, Papa A, Motta A, Di Minno MND, Maniscalco M. Clinical assessment of endothelial function in convalescent COVID-19 patients: a meta-analysis with meta-regressions. Ann Med 2022; 54:3234-3249. [PMID: 36382632 PMCID: PMC9673781 DOI: 10.1080/07853890.2022.2136403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Endothelial dysfunction has been proposed to play a key role in the pathogenesis of coronavirus disease 2019 (COVID-19) and its post-acute sequelae. Flow-mediated dilation (FMD) is recognized as an accurate clinical method to assess endothelial function. Thus, we performed a meta-analysis of the studies evaluating FMD in convalescent COVID-19 patients and controls with no history of COVID-19. METHODS A systematic literature search was conducted in the main scientific databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Using the random effects method, differences between cases and controls were expressed as mean difference (MD) with 95% confidence intervals (95% CI). The protocol was registered on PROSPERO with reference number CRD42021289684. RESULTS Twelve studies were included in the final analysis. A total of 644 convalescent COVID-19 patients showed significantly lower FMD values as compared to 662 controls (MD: -2.31%; 95% CI: -3.19, -1.44; p < 0.0001). Similar results were obtained in the sensitivity analysis of the studies that involved participants in either group with no cardiovascular risk factors or history of coronary artery disease (MD: -1.73%; 95% CI: -3.04, -0.41; p = 0.010). Interestingly, when considering studies separately based on enrolment within or after 3 months of symptom onset, results were further confirmed in both short- (MD: -2.20%; 95% CI: -3.35, -1.05; p < 0.0001) and long-term follow-up (MD: -2.53%; 95% CI: -4.19, -0.86; p = 0.003). Meta-regression models showed that an increasing prevalence of post-acute sequelae of COVID-19 was linked to a higher difference in FMD between cases and controls (Z-score: -2.09; p = 0.037). CONCLUSIONS Impaired endothelial function can be documented in convalescent COVID-19 patients, especially when residual clinical manifestations persist. Targeting endothelial dysfunction through pharmacological and rehabilitation strategies may represent an attractive therapeutic option.Key messagesThe mechanisms underlying the post-acute sequelae of coronavirus disease 2019 (COVID-19) have not been fully elucidated.Impaired endothelial function can be documented in convalescent COVID-19 patients for up to 1 year after infection, especially when residual clinical manifestations persist.Targeting endothelial dysfunction may represent an attractive therapeutic option in the post-acute phase of COVID-19.
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Affiliation(s)
- Pasquale Ambrosino
- Cardiac Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Marco Mosella
- Neurological Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Roberto Formisano
- Cardiac Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Antonio Molino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Antimo Papa
- Cardiac Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Italy
| | | | - Mauro Maniscalco
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.,Pulmonary Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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Wu H, Luo Z, Liu J, Luo D, Song L, Zhao Y. Association between psoriasis and coronary artery calcification: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:1044117. [PMID: 36505373 PMCID: PMC9732247 DOI: 10.3389/fcvm.2022.1044117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
Background Psoriasis and atherosclerosis have overlapping pathophysiological mechanisms. However, the association between psoriasis and coronary artery calcification (CAC), a hallmark of atherosclerosis and a predictor of poor cardiovascular prognosis, remains to be determined. We performed a systematic review and meta-analysis to comprehensively evaluate the association between these related inflammatory conditions. Methods Observational studies evaluating the relationship between psoriasis and CAC were retrieved by searching PubMed, Cochrane's Library, and Embase databases. Presence of CAC was confirmed according to an Agatston's Score >0 upon computed tomography examination. A random-effect model incorporating between-study heterogeneity was used to pool the results. Results Sixteen studies involving 3,039 patients with psoriasis and 46,191 controls without psoriasis were included in the meta-analysis. All participants were without previously known cardiovascular diseases. Pooled results showed that psoriasis was associated with overall CAC [odds ratio (OR): 1.54, 95% confidence interval: 1.23-1.91, p < 0.001; I 2 = 57%], after matching or adjusting the conventional cardiovascular risk factors. Subgroup analyses showed that study country, comorbidity of psoriatic arthritis, baseline Psoriasis Area and Severity Index, and duration of psoriasis (p for subgroup difference all >0.05) did not significantly affect the association of psoriasis and CAC. However, a stronger association was observed in younger patients (mean age <50 years, OR: 2.63, p < 0.001) compared to older patients (≥50 years, OR: 1.24, p = 0.02; p for subgroup difference <0.001). Conclusion Psoriasis is associated with CAC, and the association may be stronger in younger patients.
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Affiliation(s)
- Huihui Wu
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zeyu Luo
- Department of Dermatology, Guangzhou Development District Hospital, Guangzhou, China
| | - Juanhua Liu
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Diqing Luo
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Luli Song
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yukun Zhao
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Ramos S, Daya S, Crowther NJ, Pillay L, Tikly M, Goolam Mahyoodeen N. Prevalence and Predictors of Abdominal Aorta Calcification in Patients With Psoriasis—A Case Control Study. Front Med (Lausanne) 2022; 9:890195. [PMID: 35847770 PMCID: PMC9280304 DOI: 10.3389/fmed.2022.890195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Psoriasis is associated with a high prevalence of cardiovascular disease in Caucasians, but only a few studies from sub-Saharan Africa have investigated the prevalence of cardiovascular disease in patients with psoriasis. Abdominal aortic calcification (AAC) is a strong predictor of future cardiovascular events and all-cause mortality in the general population. We investigated the prevalence and risk factors for AAC in a predominantly non-Caucasian cohort of South African patients with psoriasis. Methods A cross-sectional case-control study of adult psoriasis patients (n = 69) and controls (n = 80), matched for gender, ethnicity and body mass index, attending tertiary Dermatology and Rheumatology clinics in Johannesburg, South Africa. Demographic, anthropometric, clinical and biochemical data were recorded. All participants underwent non-contrast abdominal CT scans. Images were assessed for AAC at the supra-coeliac aorta, supra-mesenteric aorta and aortic bifurcation using Horos DICOM viewer software. Results Abdominal aortic calcification at any site was more prevalent in the psoriasis than control group (47.8% vs 22.5%, p < 0.005). The aortic bifurcation was the commonest site for AAC in both groups, but more prevalent in the psoriasis group (42.0% vs 21.3%, p < 0.005). The psoriasis group was also more likely to smoke, have hypertension and type 2 diabetes (56.5% vs 25.0%, p < 0.005; 72.0% vs 55.0%, p < 0.005; 24.6% vs 3.80%, p < 0.0005, respectively). Multivariable logistic regression analysis demonstrated that age, smoking and type 2 (T2DM) diabetes were independently associated with AAC (odds ratio (95% CIs): 1.16 (1.07, 1.20), 4.30 (2.15, 8.61) and 3.45 (1.09, 15.7) respectively), but psoriasis was not. Forward regression analysis demonstrated that smoking attenuated the association of psoriasis with AAC. Conclusion Our findings show AAC to be more common in psoriasis patients compared to controls. Age, T2DM and smoking were independent predictors of AAC. Smoking cessation is essential in psoriatic patients to reduce the risk of cardiovascular events. The clinical utility of AAC detection by CT imaging to risk stratify for hard cardiovascular outcomes needs to be explored.
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Affiliation(s)
- Sofia Ramos
- Department of Diagnostic Radiology, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- *Correspondence: Sofia Ramos
| | - Sheetal Daya
- Department of Diagnostic Radiology, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J. Crowther
- Department of Chemical Pathology, National Health Laboratory Services, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lushen Pillay
- Department of Dermatology, Faculty of Health Sciences, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammed Tikly
- Department of Internal Medicine, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nasrin Goolam Mahyoodeen
- Department of Internal Medicine, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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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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Yamazaki F, Takehana K, Tanaka A, Son Y, Ozaki Y, Tanizaki H. Relationship between Psoriasis and Prevalence of Cardiovascular Disease in 88 Japanese Patients. J Clin Med 2021; 10:jcm10163640. [PMID: 34441936 PMCID: PMC8397130 DOI: 10.3390/jcm10163640] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/26/2021] [Accepted: 08/10/2021] [Indexed: 12/17/2022] Open
Abstract
Psoriasis is a systemic inflammatory disease known to affect survival in the presence of cerebral or cardiovascular comorbidities. However, no clear guidelines have been defined regarding the extent of vascular lesion testing that should be performed in patients with psoriasis. We therefore performed coronary computed tomography angiography (CCTA) in 88 Japanese patients with psoriasis who visited Kansai Medical University Hospital between 2015 and 2019 and determined the ankle–brachial pressure index (ABI) for 44 of these patients. CCTA abnormalities were found in 39 of the 88 patients, and a need for treatment was identified in 14 patients. The prevalence of cardiovascular lesions in these patients was 15.9%, significantly higher than that in the healthy Japanese population (6.38% according to the Suita Study). In the 44 patients with results for both ABI and CCTA, the rates of CCTA vascular lesions were significantly higher in cases with ABIs indicating hard vessels or above than in cases with supple, normal, or slightly stiff vessels. This is the first report to show a correlation between CCTA and ABI in psoriasis patients. ABI was considered useful as a preliminary test before CCTA. The univariate analysis of the abnormal and normal CCTA groups showed that the prevalence differed significantly among patients with psoriatic arthritis, erythrodermic psoriasis, older age, pre-existing conditions, drinking, and hypertension. The multivariate analysis showed correlations with arthritic or erythrodermic psoriasis.
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Affiliation(s)
- Fumikazu Yamazaki
- Departments of Dermatology, Kansai Medical University, Osaka 573-1010, Japan;
- Psoriasis Center, Kansai Medical University, Osaka 573-1191, Japan; (K.T.); (A.T.); (Y.S.); (Y.O.)
- Correspondence: ; Tel.: +81-072-804-2764
| | - Kazuya Takehana
- Psoriasis Center, Kansai Medical University, Osaka 573-1191, Japan; (K.T.); (A.T.); (Y.S.); (Y.O.)
- Division of Cardiology, Departments of Medicine II, Kansai Medical University, Osaka 573-1010, Japan
| | - Akihiro Tanaka
- Psoriasis Center, Kansai Medical University, Osaka 573-1191, Japan; (K.T.); (A.T.); (Y.S.); (Y.O.)
- Division of Rheumatology, Departments of Medicine I, Kansai Medical University, Osaka 573-1010, Japan
| | - Yonsu Son
- Psoriasis Center, Kansai Medical University, Osaka 573-1191, Japan; (K.T.); (A.T.); (Y.S.); (Y.O.)
- Division of Rheumatology, Departments of Medicine I, Kansai Medical University, Osaka 573-1010, Japan
| | - Yoshio Ozaki
- Psoriasis Center, Kansai Medical University, Osaka 573-1191, Japan; (K.T.); (A.T.); (Y.S.); (Y.O.)
- Division of Rheumatology, Departments of Medicine I, Kansai Medical University, Osaka 573-1010, Japan
| | - Hideaki Tanizaki
- Departments of Dermatology, Kansai Medical University, Osaka 573-1010, Japan;
- Psoriasis Center, Kansai Medical University, Osaka 573-1191, Japan; (K.T.); (A.T.); (Y.S.); (Y.O.)
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Porta S, Otero-Losada M, Kölliker Frers RA, Cosentino V, Kerzberg E, Capani F. Adipokines, Cardiovascular Risk, and Therapeutic Management in Obesity and Psoriatic Arthritis. Front Immunol 2021; 11:590749. [PMID: 33643281 PMCID: PMC7902722 DOI: 10.3389/fimmu.2020.590749] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
Psoriatic arthritis is a chronic inflammatory disease with skin and joint pathology as the dominant characteristics. Scientific evidence supports its systemic nature and relevant relationship with obesity, metabolic syndrome, and associated conditions. Metabolic syndrome and obesity share common signaling pathways with joint inflammation, reinforcing the idea that adipose tissue is a major contributor to disease development and severity. The adipose tissue is not a mere energy store but also an endocrine organ participating in the immune response. In the search for the best therapeutic strategy for a patient, we should appraise the adipose tissue as an endocrine and immune organ responsible for mild chronic inflammation. Today, our challenge is not only to achieve disease remission but to control the associated comorbidities as well. In light of the high prevalence of obesity in psoriatic arthritis patients and the importance of the adipose tissue in the development of chronic inflammation, we aimed to identify the most relevant articles in this regard published in English until June 2020 using the PubMed database. Search terms included psoriatic arthritis, in combination with metabolic syndrome, obesity, adipokines, cardiovascular disease, and treatment. This review summarizes the current evidence regarding the role of adipose tissue as an adipokine-secreting endocrine organ, discussing its influence on disease development and severity, and ultimately in meeting successful disease management.
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Affiliation(s)
- Sabrina Porta
- Rheumatology Department, J. M. Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Matilde Otero-Losada
- Biomedical Research Center, Interamerican Open University, National Research Council (CAECIHS-UAI. CONICET), Buenos Aires, Argentina
| | - Rodolfo A Kölliker Frers
- Rheumatology Department, J. M. Ramos Mejía Hospital, Buenos Aires, Argentina.,Biomedical Research Center, Interamerican Open University, National Research Council (CAECIHS-UAI. CONICET), Buenos Aires, Argentina
| | - Vanesa Cosentino
- Rheumatology Department, J. M. Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Eduardo Kerzberg
- Rheumatology Department, J. M. Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Francisco Capani
- Biomedical Research Center, Interamerican Open University, National Research Council (CAECIHS-UAI. CONICET), Buenos Aires, Argentina.,Department of Biology, University John F. Kennedy, Buenos Aires, Argentina.,Universidad Autónoma de Chile, Santiago, Chile
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11
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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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12
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Atzeni F, Nucera V, Gerratana E, Fiorenza A, Gianturco L, Corda M, Sarzi-Puttini P. Cardiovascular Consequences of Autoimmune Rheumatic Diseases. Curr Vasc Pharmacol 2020; 18:566-579. [PMID: 31985379 DOI: 10.2174/1570161118666200127142936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/23/2019] [Accepted: 12/28/2019] [Indexed: 12/23/2022]
Abstract
The increased risk of cardiovascular disease (CVD) among patients with autoimmune rheumatic diseases such as rheumatoid arthritis, spondyloarthritis and systemic lupus erythematosus has been extensively documented. Sub-clinical atherosclerosis can be assessed using various non-invasive imaging techniques. However, the mechanisms underlying the higher risk of atherosclerotic CVD in patients with autoimmune rheumatic diseases are not fully known, although they seem to include chronic low-grade systemic inflammation leading to prolonged endothelial activation, accompanied by a pro-thrombotic/pro-coagulant and autoantibody state. Furthermore, sub-clinical atherosclerosis is also influenced by other traditional risk factors for CVD. Including the individual components of the metabolic syndrome (MetS: obesity, impaired glucose metabolism, dyslipidemia and high blood pressure), the degree of which is higher in these patients than in controls. The aim of this narrative review is to discuss the CV manifestations and risk factors involved in the increased risk of CVD among patients with autoimmune rheumatic diseases.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Italy
| | - Valeria Nucera
- Rheumatology Unit, University of Messina, Messina, Italy
| | | | | | - Luigi Gianturco
- Cardiology Unit, Beato Matteo Hospital, GSD Hospitals, Vigevano, Pavia, Italy
| | - Marco Corda
- Cardiology Unit, Brotzu Hospital, Cagliari, Italy
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13
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Ambrosino P, Parrella P, Formisano R, Papa A, Spedicato GA, Di Minno MND, Motta A, Maniscalco M. Clinical application of nasal nitric oxide measurement in allergic rhinitis: A systematic review and meta-analysis. Ann Allergy Asthma Immunol 2020; 125:447-459.e5. [PMID: 32663599 DOI: 10.1016/j.anai.2020.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/19/2020] [Accepted: 07/06/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nasal nitric oxide (nNO) is considered a biomarker of nasal inflammation. OBJECTIVE To perform a systematic review with meta-analysis and meta-regressions on the association between nNO levels and allergic rhinitis (AR). METHODS PubMed, Web of Science, Scopus, and EMBASE databases were systematically searched. Differences between cases and controls were expressed as standardized mean differences (SMD) with 95% confidence intervals (CI). RESULTS Overall, 39 articles were included: 30 containing data on nNO measured by nasal aspiration (1881 patients with AR and 1337 controls) and 12 assessing nNO by nasal exhalation (525 patients with AR and 350 controls). Compared with controls, AR presented significantly higher nNO values both during nasal aspiration (SMD, 1.309; 95% CI, 0.841-1.777; P < .001) and nasal exhalation (SMD, 0.708; 95% CI, 0.303-1.114; P = .001). Sensitivity and subgroup analyses confirmed that the results for the evaluated outcomes were not affected by the presence of clinical confounding factors (asthma, nasal polyps, inhaled corticosteroids, smoking history), this being valid for both perennial and seasonal diseases during exposure to allergens. For the aspiration method, meta-regressions indicated that older age and a better pulmonary function were associated with a lower difference in nNO levels between patients with AR and controls, whereas an increasing aspiration flow was associated with a high effect size. CONCLUSION nNO levels are higher in AR, particularly when using high aspiration flows and in younger patients, who often perceive this condition as a source of disability. Further studies are needed to evaluate the usefulness of this biomarker for monitoring airway disorders and optimizing strategies in different settings (community, hospital, rehabilitation).
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Affiliation(s)
| | - Paolo Parrella
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Antimo Papa
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | | | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Naples, Italy
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14
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Mendonça JA, Pansani LN, Mimoto MB, Ferreira ITG, Sanches FB, de Campos Ferreira Pinto T, Leandro-Merhi VA, de Aquino JLB. Nail enthesis ultrasound and automated software-guided assessment of bilateral common carotid intima-media thickness in psoriasis and psoriatic arthritis: is there a correlation with clinical and laboratory findings? Drugs Context 2020; 9:2020-1-2. [PMID: 32547626 PMCID: PMC7271708 DOI: 10.7573/dic.2020-1-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Ultrasound (US) in psoriasis (PsO) and psoriatic arthritis (PsA) is an important tool in several situations to detect joint ecostructural damage as well as other tissue alterations, such as those that occur in the larger vessels. The objective of this study was to detect and correlate the changes that indicate the inflammatory and atherosclerotic process in two groups of patients, using nail US and carotid artery intima-media thickness radiofrequency (RF) software. METHODS A total of 30 patients diagnosed with (PsO) and (PsA) were selected. About 15 patients were present in each group, assigned by the Dermatology and Rheumatology Service of the Universidade Pontifícia Católica de Campinas, São Paulo, Brazil, and were assessed using carotid artery US (radiofrequency quality intima-media thickness [RF-QIMT]), joint US, clinical evaluation, and laboratory tests. RESULTS Spearman and Pearson correlations between US variables per group were Psoriasis Area and Severity Index (PASI) and loss of the nail pattern trilaminar: r=0.658, p=0.015; Framingham Score (FS) and Internal Resistance Index (IR): 0.351 to 0.526, p=0.034 to 0.002; the significant correlations by the Bayesian factor (BF) were those with a BF greater than 2.5, between QIMT expected with FS: r=0.677, BF=10.06, with total cholesterol: r=0.5232, BF=2.60, and QIMT-RF with low density lipoproteins: r=0.633, BF=3.70. CONCLUSION The use of US in the evaluation of these patients showed significant correlations between clinical and laboratory measures, characterized by QIMT and FS as well as changes in nail insertion. Future studies may demonstrate an even better interaction.
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Affiliation(s)
- José Alexandre Mendonça
- Serviço de Reumatologia, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
- Health Sciences Post-Graduation Program, PUC-Campinas – SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil
| | - Lucas Nogueira Pansani
- Serviço de Reumatologia, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | - Mateus Basso Mimoto
- Serviço de Reumatologia, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | | | | | | | - Vania Aparecida Leandro-Merhi
- Health Sciences Post-Graduation Program, PUC-Campinas – SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil
| | - José Luis Braga de Aquino
- Health Sciences Post-Graduation Program, PUC-Campinas – SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil
- Serviço de Clínica Cirúrgica e Pós Graduação da Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
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Martínez-Vidal MP, Andrés M, Jovaní V, Santos-Ramírez C, Romera C, Fernández-Carballido C. Role of Carotid Ultrasound and Systematic Coronary Risk Evaluation Charts for the Cardiovascular Risk Stratification of Patients with Psoriatic Arthritis. J Rheumatol 2020; 47:682-689. [PMID: 31203214 DOI: 10.3899/jrheum.181223] [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] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The assessment of the cardiovascular (CV) risk is recommended in patients with chronic inflammatory rheumatic diseases. The objectives of this study were to assess the CV risk profile in a cohort of patients with psoriatic arthritis (PsA), to determine the presence of subclinical cardiovascular disease by carotid ultrasound (US), and to study the association of CV disease to PsA characteristics. METHODS This was a cross-sectional multicentric descriptive study. The clinical CV risk was calculated with Systematic Coronary Risk Evaluation (SCORE) charts. Common carotid US was conducted to evaluate the carotid wall intima-media thickness and the presence of atheroma plaques. Patients were reclassified upon US results. Multivariate analyses were performed to identify associations of US carotid abnormalities with the classical CV risk factors and PsA characteristics. RESULTS The study included 176 patients with PsA. The SCORE-estimated CV risk was intermediate in 65.3% of the patients. In the US study, 32% of the patients had abnormalities, and 30.8% of the patients were upgraded and reclassified as very high risk owing to the presence of atheroma. Subclinical CV disease was associated with age and dyslipidemia but not with other risk factors. It was associated with axial disease in the subgroup with intermediate risk, and with C-reactive protein levels in patients with high risk. CONCLUSION Many patients with PsA have clinical estimated intermediate or high risk of a fatal CV event. A carotid US study detects subclinical vascular disease and may be useful to depict the real risk. The presence of atheroma is only partially explained by the classic CV risk factors.
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Affiliation(s)
- María Paz Martínez-Vidal
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain. .,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan.
| | - Mariano Andrés
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain.,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan
| | - Vega Jovaní
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain.,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan
| | - Carlos Santos-Ramírez
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain.,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan
| | - Cintia Romera
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain.,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan
| | - Cristina Fernández-Carballido
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain.,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan
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Usefullnes of atherogenic indices and Ca-LDL level to predict subclinical atherosclerosis in patients with psoriatic arthritis? Adv Rheumatol 2019; 59:49. [PMID: 31727163 DOI: 10.1186/s42358-019-0096-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/01/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To investigate the link between carbamylated low-density lipoprotein (ca-LDL), atherogenic index of plasma (AIP), atherogenic coefficient (AC), Castelli's risk indices I and II (CRI I and II) and subclinic atherosclerosis in psoriatic arthritis (PsA). METHODS Thirty-ninepatients and 19 age, sex, body mass index matched healthy controls were included. Insulin resistance (IR) was assessed with homeostasis of model assessment-IR (HOMA-IR). Carotid intima-media thickness (CIMT) was measured at both common carotid arteries and mean CIMT was calculated. RESULTS The mean age was 49.50 ± 11.86 years and 64.1% were females in PsA group. In the PsA group, CIMT and HOMA-IR were significantly higher (p = 0.003, p = 0.043, respectively). AIP, AC, TG/HDL, CRI-1, CRI-2 and ca-LDL levels were similar between groups. In PsA group, CIMT was positively correlated with HOMA-IR, TG/HDL and AIP. Although ca-LDL was positively correlated with serum amyloid A (r = 0.744, p < 0.001), no correlation was detected between ca-LDL and CIMT (r = 0.215, p = 0.195). PsA patients with IR tended to have higher ca-LDL levels than patients without IR, but this difference lacked statistical significance (33.65 ± 26.94, 28.63 ± 28.06, respectively, p = 0.237). CONCLUSIONS A significant increase in CIMT was seen in PsA patients without clinically evident cardiovascular disease or any traditional atherosclerosis risk factors. CIMT was correlated with HOMA-IR, TG/HDL and AIP.
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Increased Prevalence of Metabolic Syndrome and Adipocytokine Levels in a Psoriatic Arthritis Cohort. J Clin Rheumatol 2019; 24:302-307. [PMID: 29708516 DOI: 10.1097/rhu.0000000000000721] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to evaluate the prevalence of metabolic syndrome (MetS) in psoriatic arthritis (PsA) patients according to the most recent definition in a Mediterranean population and to determine its association with biomarkers of inflammation and serum adipocytokine levels. METHODS Demographic, clinical, and laboratory data were collected on 74 patients with PsA and 82 control subjects. The presence of MetS was determined according to the current "harmonization" definition. Serum adipocytokines were analyzed. Continuous variables were compared by t test and discrete variables by χ test. Multivariate regression models compared the association between the presence of MetS and the blood levels of adipocytokines. RESULTS The prevalence of MetS was higher in PsA patients compared with the control group: 54.8% versus 36.6%, respectively (P = 0.02; odds ratio, 2.33; 95% confidence interval, 1.16-4.69). The main difference between the 2 groups was waist circumference. No association was found between MetS and parameters of articular and skin disease activity or treatment. Leptin levels and leptin/adiponectin ratio were higher in PsA patients compared with control subjects: 83.4 versus 51.7 ng/mL (P = 0.001) and 6.3 × 10 versus 4.1 × 10 (P = 0.015), respectively. There was no significant difference in the adiponectin levels between the groups. CONCLUSIONS The prevalence of MetS was higher in PsA patients compared with non-PsA control subjects in this Mediterranean population. Clinicians caring for PsA patients ought to be aware of the increased risk of MetS in PsA patients, confirmed in different regions worldwide. The increased MetS seems to be linked to central obesity in these patients, and appropriate treatment recommendations are advised.
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18
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Kaiser H, Abdulla J, Henningsen KMA, Skov L, Hansen PR. Coronary Artery Disease Assessed by Computed Tomography in Patients with Psoriasis: A Systematic Review and Meta-Analysis. Dermatology 2019; 235:478-487. [PMID: 31480039 DOI: 10.1159/000502138] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with psoriasis have an increased risk of coronary artery disease (CAD) but data on coronary calcium score (CCS) and cardiac computed tomography angiography (CCTA) are inconsistent. OBJECTIVES The present study quantitatively summarizes the literature data on the prevalence and burden of CAD in patients with psoriasis compared with controls using CCS and CCTA. METHODS A systematic review and meta-analysis was conducted. The search included all studies examining CAD prevalence and burden detected by CCS with or without CCTA in patients with psoriasis without prior CAD compared with controls, between the year 2000 and May 30, 2018. RESULTS Fourteen eligible studies provided data on 1,427 patients with psoriasis and 9,670 controls. Pooled data provided the estimated risk ratio (RR) of CAD and weighted mean differences of CCS in psoriasis patients versus controls. Meta-analysis of the prevalence and burden of CCS showed that patients with psoriasis had an increased risk of CAD (RR 1.14, 95% CI 1.04-1.26; p = 0.004), and for more severe CAD (CCS >100) the risk was further increased (RR 1.71, 95% CI 1.28-2.30; p < 0.001) compared with controls. Weighted mean difference for CCS was significantly higher in patients with psoriasis (12.74, 95% CI 10.70-14.78; p < 0.001). The risk of high-risk coronary plaques identified by CCTA was also significantly higher in psoriasis patients compared with controls (RR 1.77, 95% CI 1.37-2.28; p < 0.001). CONCLUSIONS Patients with psoriasis have a higher prevalence of subclinical CAD, a higher burden of the disease, and more high-risk coronary plaques compared with controls without psoriasis.
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Affiliation(s)
- Hannah Kaiser
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark,
| | - Jawdat Abdulla
- Department of Medicine, Section of Cardiology, Glostrup University Hospital, Glostrup, Denmark
| | | | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Riis Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Peluso R, Caso F, Tasso M, Ambrosino P, Dario Di Minno MN, Lupoli R, Criscuolo L, Caso P, Ursini F, Puente AD, Scarpa R, Costa On Behalf Of CaRRDs Study Group L. Cardiovascular Risk Markers and Major Adverse Cardiovascular Events in Psoriatic Arthritis Patients. Rev Recent Clin Trials 2018. [PMID: 29542417 PMCID: PMC6691775 DOI: 10.2174/1574887113666180314105511] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Psoriatic arthritis is a chronic inflammatory arthropathy that affects 14%- 30% of patients with skin and/or nail psoriasis, leading to severe physical limitations and disability. It has been included in the group of spondyloarthropathy with which it shares clinical, radiologic, and serologic features in addition to familial and genetic relationship. Beyond skin and joint involvement, psoriatic arthritis is characterized by a high prevalence of extra-articular manifestation and comorbidities, such as autoimmune, infectious and neoplastic diseases. In particular, an increased risk of cardiovascular comorbidity has been observed in psoriatic arthritis patients. METHODS A systematic search was performed in the electronic databases (PubMed, Web of Science, Scopus, EMBASE) up until January 2017. Studies were included if they contained data on CV disease and/or risk factors in PsA and each article was then reviewed for quality and clinical relevance. After completing the literature search all screened literature was summarized and discussed in our study group (CaRDDs study group). All literature and comments were included in the systematic review. RESULTS The initial search produced 278 abstracts, which were narrowed to 83 potentially relevant articles by preliminary review of the titles and by excluding review articles and case report (n = 195). Thirty articles were deemed ineligible after examining the abstracts. Full texts of the remaining 53 articles were retrieved. The majority of articles excluded were due to only providing data on patients with psoriasis or due to being not relevant to the CV risk in PsA. In the end, 32 articles were deemed eligible for this review. CONCLUSION Psoriatic arthritis appeared significantly associated with subclinical atherosclerosis and endothelial dysfunction and, in turn, with an increased cardiovascular risk. Thus, patients with psoriatic arthritis may benefit from a periodic assessment of surrogate markers of cardiovascular risk. This could help to establish more specific cardiovascular prevention strategies for these patients.
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Affiliation(s)
- Rosario Peluso
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
| | - Francesco Caso
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
| | - Marco Tasso
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
| | - Pasquale Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Roberta Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Livio Criscuolo
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
| | - Paolo Caso
- Geriatric Unit, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Francesco Ursini
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Antonio Del Puente
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
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20
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Dattilo G, Borgia F, Guarneri C, Casale M, Bitto R, Morabito C, Signorelli S, Katsiki N, Cannavò SP. Cardiovascular Risk in Psoriasis: Current State of the Art. Curr Vasc Pharmacol 2018; 17:85-91. [DOI: 10.2174/1570161115666171116163816] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 10/23/2017] [Accepted: 10/23/2017] [Indexed: 02/07/2023]
Abstract
Psoriasis (Pso) is a chronic inflammatory immune-mediated skin disease associated with
several comorbidities. Despite the growing number of studies providing evidence for the link between
Pso and Cardiovascular (CV) disorders, there are still many unsolved questions, dealing with the role of
the skin disease as an independent risk factor for CV events, the influence of Pso severity and duration
on CV damage, the presence of Psoriatic Arthritis (PsA) as a predictor of increased CV mortality and
morbidity and the detection of reliable clinical, laboratory and/or instrumental parameters to stratify CV
risk in psoriatic patients. Moreover, it remains to clarify if the early treatment of the dermatosis may
lower CV risk. In this paper we will try to provide answers to these queries in the light of the updated
data of the literature.
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Affiliation(s)
- Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Messina, Italy
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Claudio Guarneri
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Matteo Casale
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Messina, Italy
| | - Roberto Bitto
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Messina, Italy
| | - Claudia Morabito
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Messina, Italy
| | - Salvatore Signorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Niki Katsiki
- Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Serafinello P. Cannavò
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
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Systemic Inflammatory Response and Atherosclerosis: The Paradigm of Chronic Inflammatory Rheumatic Diseases. Int J Mol Sci 2018; 19:ijms19071890. [PMID: 29954107 PMCID: PMC6073407 DOI: 10.3390/ijms19071890] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/17/2018] [Accepted: 06/20/2018] [Indexed: 12/17/2022] Open
Abstract
Patients with Chronic Inflammatory Rheumatic diseases (CIRD) are at increased risk of cardiovascular disease (CVD), ascribed not only to classical risk factors, but also to the presence of chronic systemic inflammatory response. Αtherosclerosis, the cornerstone of CVD, is known to be accelerated in CIRD; rheumatoid arthritis promotes atheromatosis and associates with preclinical atherosclerosis equivalent to Diabetes Mellitus, which also seems to apply for systemic lupus erythematosus. Data on ankylosing spondylitis and psoriatic arthritis, albeit more limited, also support an increased CV risk in these patients. The association between inflammation and atherosclerosis, has been thoroughly investigated in the last three decades and the role of inflammation in the pathogenesis and progression of atherogenesis has been well established. Endothelial dysfunction, oxidative stress in vascular endothelial cells and macrophage accumulation, toll-like receptor signaling, NLPR-3 formation and subsequent pro-inflammatory cytokine production, such as TNFa, IL-1β, IL-6, and TNF-like cytokine 1A, are few of the mechanisms implicated in the atherogenic process. Moreover, there is evidence that anti-inflammatory biologic drugs, such as anti-TNF and anti-IL1β agents, can decelerate the atherogenic process, thus setting new therapeutic targets for early and effective disease control and suppression of inflammation, in addition to aggressive management of classical CV risk factors.
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Ucar O. Delivering Precision Medicine and Patient-Centred Care Through a Multidisciplinary Approach. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10313695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The current treatment strategy for patients with inflammatory bowel disease (IBD) aims to enable physicians to deliver optimal care and to improve the role that patients play in treatment decisions. The multidisciplinary team (MDT) approach integrates the patient’s perspective and sees the discussion of treatment options with both gastroenterologists and surgeons as early as possible. The MDT approach is also vital in managing the risk of IBD and cardiovascular-related comorbidities in patients with psoriasis (PsO) and psoriatic arthritis (PsA), where selection of appropriate medication may affect both the rheumatic condition and the associated comorbidity. Close interdisciplinary interactions between gastroenterologists, rheumatologists, and/or dermatologists are vital, and the ensuing knowledge transfer facilitates the provision of optimal patient care. Personalised medicine will have a profound impact on future treatment algorithms in IBD and other chronic inflammatory conditions. Owing to the complexity of these diseases, a novel approach is urgently needed that will aggregate data from multiple systems and integrate it into a so-called ‘IBD interactome’. This may help identify and target the key molecular components responsible for inflammation. Future treatment practices will also address the psychosocial aspects of IBD by empowering patients and integrating their perspective into the shared treatment decision-making process early on.
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Is the SCORE chart underestimating the real cardiovascular (CV) risk of patients with psoriatic arthritis? Prevalence of subclinical CV disease detected by carotid ultrasound. Joint Bone Spine 2018; 85:327-332. [DOI: 10.1016/j.jbspin.2017.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/03/2017] [Indexed: 11/23/2022]
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Cardiometabolic Comorbidities in Psoriasis and Psoriatic Arthritis. Int J Mol Sci 2017; 19:ijms19010058. [PMID: 29295598 PMCID: PMC5796008 DOI: 10.3390/ijms19010058] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023] Open
Abstract
There is solid epidemiologic evidence linking psoriasis and psoriatic arthritis (PsA) to cardiovascular risk factors and an increased risk of developing cardiovascular disease. Chronic inflammation, with shared pathways and cytokines common to metabolic syndrome, atherosclerosis and psoriasis, might provide the basis for the cardiovascular and metabolic comorbidities of psoriasis and PsA. The purpose of this manuscript is to review recent evidence about the epidemiology and underlying mechanisms of cardiovascular risk factors and cardiovascular disease in patients with psoriasis and/or PsA; the use of analytical determinations, physiologic measures and imaging techniques as surrogate biomarkers of atherosclerosis, endothelial dysfunction and cardiovascular disease in these patients; and the epidemiological and clinical data, including results of clinical trials, supporting a cardioprotective role of anti-inflammatory and disease-modifying treatment in psoriasis and PsA.
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Cardiovascular morbidity and mortality in patients with rheumatic disease: hyperuricemia, a forgotten puzzle piece? Clin Rheumatol 2017; 36:2869-2870. [DOI: 10.1007/s10067-017-3881-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/09/2017] [Accepted: 10/15/2017] [Indexed: 10/18/2022]
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Schemoul J, Poulain C, Claudepierre P. Treatment strategies for psoriatic arthritis. Joint Bone Spine 2017; 85:537-544. [PMID: 29155104 DOI: 10.1016/j.jbspin.2017.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 01/02/2023]
Abstract
The therapeutic management of psoriatic arthritis has seen major changes over the last few years, as illustrated by the recent updates of the GRAPPA and EULAR recommendations. These changes were driven by new studies establishing important benefits from early management and tight control of disease activity. The concepts underlying the treatment of psoriatic arthritis must be reappraised in the light of these new data. The objectives of this review are to discuss new concepts, to describe and assess the new drug classes introduced for psoriatic arthritis and, whenever possible, to define the specific indications of each class based on the rheumatic disease phenotype and presence of extraarticular manifestations.
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Affiliation(s)
- Julien Schemoul
- Service de rhumatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Cécile Poulain
- Service de rhumatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Pascal Claudepierre
- Service de rhumatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; EA 7379, Epiderm E, université Paris Est-Créteil, 94010 Créteil, France.
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Shen J, Lam SH, Shang Q, Wong CK, Li EK, Wong P, Kun EW, Cheng IT, Li M, Li TK, Zhu TY, Lee JJW, Chang M, Lee APW, Tam LS. Underestimation of Risk of Carotid Subclinical Atherosclerosis by Cardiovascular Risk Scores in Patients with Psoriatic Arthritis. J Rheumatol 2017; 45:218-226. [DOI: 10.3899/jrheum.170025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/22/2022]
Abstract
Objective.To test the performances of established cardiovascular (CV) risk scores in discriminating subclinical atherosclerosis (SCA) in patients with psoriatic arthritis.Methods.These scores were calculated: Framingham risk score (FRS), QRISK2, Systematic COronary Risk Evaluation (SCORE), 10-year atherosclerotic cardiovascular disease risk algorithm (ASCVD) from the American College of Cardiology and the American Heart Association, and the European League Against Rheumatism (EULAR)–recommended modified versions (by 1.5 multiplication factor, m-). Carotid intima-media thickness > 0.9 mm and/or the presence of plaque determined by ultrasound were classified as SCA+.Results.We recruited 146 patients [49.4 ± 10.2 yrs, male: 90 (61.6%)], of whom 142/137/128/118 patients were eligible to calculate FRS/QRISK2/SCORE/ASCVD. Further, 62 (42.5%) patients were SCA+ and were significantly older, with higher systolic blood pressure and higher low-density lipoprotein cholesterol (all p < 0.05). All CV risk scores were significantly higher in patients with SCA+ [FRS: 7.8 (3.9–16.5) vs 2.7 (1.1–7.8), p < 0.001; QRISK2: 5.5 (3.1–10.2) vs 2.9 (1.2–6.3), p < 0.001; SCORE: 1 (0–2) vs 0 (0–1), p < 0.001; ASCVD: 5.6 (2.6–12.4) vs 3.4 (1.4–6.1), p = 0.001]. The Hosmer-Lemeshow test revealed moderate goodness of fit for the 4 CV scores (p ranged from 0.087 to 0.686). However, of the patients with SCA+, those identified as high risk were only 44.1% (by FRS > 10%), 1.8% (QRISK2 > 20%), 10.9% (SCORE > 5%), and 43.6% (ASCVD > 7.5%). By applying the EULAR multiplication factor, 50.8%/14.3%/14.5%/54.5% of the patients with SCA+ were identified as high risk by m-FRS/m-QRISK2/m-SCORE/m-ASCVD, respectively. EULAR modification increased the sensitivity of FRS and ASCVD in discriminating SCA+ from 44% to 51%, and 44% to 55%, respectively.Conclusion.All CV risk scores underestimated the SCA+ risk. EULAR–recommended modification improved the sensitivity of FRS and ASCVD only to a moderate level.
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Hu SCS, Lan CCE. Psoriasis and Cardiovascular Comorbidities: Focusing on Severe Vascular Events, Cardiovascular Risk Factors and Implications for Treatment. Int J Mol Sci 2017; 18:ijms18102211. [PMID: 29065479 PMCID: PMC5666891 DOI: 10.3390/ijms18102211] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022] Open
Abstract
Psoriasis is a common and chronic inflammatory disease of the skin. It may impair the physical and psychosocial function of patients and lead to decreased quality of life. Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. More recently, studies have shown that psoriasis is a systemic inflammatory disorder which can be associated with various comorbidities. In particular, psoriasis is associated with an increased risk of developing severe vascular events such as myocardial infarction and stroke. In addition, the prevalence rates of cardiovascular risk factors are increased, including hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome. Consequently, mortality rates have been found to be increased and life expectancy decreased in patients with psoriasis, as compared to the general population. Various studies have also shown that systemic treatments for psoriasis, including methotrexate and tumor necrosis factor-α inhibitors, may significantly decrease cardiovascular risk. Mechanistically, the presence of common inflammatory pathways, secretion of adipokines, insulin resistance, angiogenesis, oxidative stress, microparticles, and hypercoagulability may explain the association between psoriasis and cardiometabolic disorders. In this article, we review the evidence regarding the association between psoriasis and cardiovascular comorbidities, focusing on severe vascular events, cardiovascular risk factors and implications for treatment.
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Affiliation(s)
- Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
| | - Cheng-Che E Lan
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
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Li Y, Golden JB, Camhi MI, Zhang X, Fritz Y, Diaconu D, Ivanco TL, Simon DI, Kikly K, McCormick TS, Wang Y, Ward NL. Protection from Psoriasis-Related Thrombosis after Inhibition of IL-23 or IL-17A. J Invest Dermatol 2017; 138:310-315. [PMID: 28951241 DOI: 10.1016/j.jid.2017.09.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/29/2017] [Accepted: 09/12/2017] [Indexed: 12/19/2022]
Abstract
Psoriasis patients experience chronic systemic skin inflammation and develop cardiovascular comorbidities that shorten their lifespan. Whether cardiovascular disease is improved by treatment with current biologics that target disease-specific pathways is unclear. KC-Tie2 mice develop psoriasiform skin inflammation with increases in IL-23 and IL-17A and proinflammatory monocytosis and neutrophilia that precedes development of carotid artery thrombus formation. To examine whether targeted blockade of IL-23 or IL-17A in KC-Tie2 psoriasis mice improves cardiovascular outcomes, mice were treated systemically for 6 weeks with antibodies targeting IL-17A, IL-17RA, IL-12/23p40, or IL-23p19. Skin inflammation; thrombosis clotting times; and percentage of splenic monocytes, neutrophils, and CD4 T cells were examined. Skin inflammation significantly improved in KC-Tie2 mice treated with each of the antibodies targeting IL-23, IL-17A, or IL-17RA, consistent with clinical efficacy observed in psoriasis patients. The time to occlusive thrombus formation lengthened in these mice and correlated with attenuated acanthosis. This decrease in skin inflammation paralleled decreases in splenic neutrophils (CD11b+Ly6G+) but not monocytes (CD11b+Ly6Chigh) or T cells (CD4+). Our data show that targeted inhibition of IL-23 or IL-17A improves psoriasis-like skin disease and also improves cardiovascular disease in mice.
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Affiliation(s)
- Yumeng Li
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jackelyn B Golden
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Maya I Camhi
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Xiufen Zhang
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yi Fritz
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Doina Diaconu
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Tammy L Ivanco
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Daniel I Simon
- Department of Medicine, Division of Cardiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Cardiovascular Research Institute, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Thomas S McCormick
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Yunmei Wang
- Department of Medicine, Division of Cardiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Cardiovascular Research Institute, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nicole L Ward
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
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Abstract
PURPOSE OF REVIEW Patients with psoriasis and psoriatic arthritis, collectively termed psoriatic disease (PsD), are at an increased risk of developing cardiovascular diseases (CVD). The purpose if this manuscript is to review recent evidence about the epidemiology and underlying mechanisms of CVD in psoriatic patients and approaches to improve the management of these comorbidities. RECENT FINDINGS Studies have shown that CVD risk is independent of traditional cardiovascular risk factors and is related to the systemic inflammatory nature of PsD. The use of surrogate markers, such as imaging of subclinical atherosclerosis, allows detection of patients at high cardiovascular risk before the occurrence of clinical events. These modalities could be clinically useful as clinical cardiovascular risk algorithms, such as the Framingham Risk Score, and have been shown to underestimate the actual cardiovascular risk in patients with PsD. Additional challenges related to the management of CVD in psoriatic patients include the underdiagnosis and undertreatment of traditional cardiovascular risk factors in rheumatology, dermatology and primary care setting. Effective measures used to control PsD, such as tumour necrosis factor inhibitors and methotrexate, has been associated with reduced cardiovascular risk in psoriatic patients. These findings highlight the importance of controlling disease activity as potential target that could lead to reduced cardiovascular risk. Together this highlights the importance of optimization of cardiovascular risk stratification and management of cardiovascular risk factors in patients with PsD.
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Affiliation(s)
- Curtis Sobchak
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lihi Eder
- Division of Rheumatology, Women's College Hospital, 76 Grenville St, Toronto, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Lupoli R, Ambrosino P, Tortora A, Barba L, Lupoli GA, Di Minno MND. Markers of atherosclerosis in patients with Cushing's syndrome: a meta-analysis of literature studies. Ann Med 2017; 49:206-216. [PMID: 27763781 DOI: 10.1080/07853890.2016.1252055] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Several studies reported an increased cardiovascular (CV) risk in Cushing's syndrome (CS). We performed a meta-analysis on the impact of CS on major markers of atherosclerosis. METHODS Studies on intima-media thickness (IMT), carotid plaques prevalence, and flow-mediated dilation (FMD) in CS patients and controls were searched in the PubMed, Web of Science, Scopus, and EMBASE. Differences between cases and controls were expressed as mean difference (MD) with 95% confidence intervals (95%CI) for continuous variables, and as Odds Ratio (OR) with 95%CI for dichotomous variables. RESULTS Fourteen studies (332 CS, 462 controls) were included. Compared with controls, CS patients showed higher IMT (MD: 0.20 mm; 95% CI: 0.12, 0.28; p < .001), increased prevalence of carotid plaques (OR: 8.85, 95%CI: 4.09, 19.14; p < .001), and lower FMD (MD: -2.65%; 95% CI: -3.65, -1.65; p < .001). Difference in IMT and in the prevalence of carotid plaques was confirmed also in patients with CS remission (MD: 0.24 mm; 95% CI: 0.07, 0.40; p = .005 and OR: 9.88, 95%CI: 2.69, 36.3; p < 0.001, respectively). Regression models showed that age, diabetes, obesity, ACTH-dependent CS, serum and urinary cortisol levels impacted on the observed difference in IMT. CONCLUSIONS CS is significantly associated with markers of subclinical atherosclerosis and CV risk. These findings could help establish more specific CV prevention strategies in this clinical setting. Key messages A series of studies reported an increased cardiovascular risk in patients with Cushing's syndrome (CS). In the present meta-analysis we demonstrated that CS is associated with an increased intima-media thickness, higher prevalence of carotid plaques, and lower flow-mediated dilation as compared with controls. These data consistently suggest the need for a strict monitoring of early signs of subclinical atherosclerosis in CS patients.
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Affiliation(s)
- Roberta Lupoli
- a Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy
| | - Pasquale Ambrosino
- a Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy
| | - Anna Tortora
- a Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy
| | - Livia Barba
- a Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy
| | - Gelsy Arianna Lupoli
- a Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy
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Moroni L, Selmi C, Angelini C, Meroni PL. Evaluation of Endothelial Function by Flow-Mediated Dilation: a Comprehensive Review in Rheumatic Disease. Arch Immunol Ther Exp (Warsz) 2017; 65:463-475. [DOI: 10.1007/s00005-017-0465-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/03/2017] [Indexed: 12/18/2022]
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Shen J, Wong KT, Cheng IT, Shang Q, Li EK, Wong P, Kun EW, Law MY, Yip R, Yim I, Ying S, Li M, Li TK, Wong CK, Zhu TY, Lee JJW, Chang M, Lee APW, Tam LS. Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease. Ann Rheum Dis 2017; 76:1237-1244. [PMID: 28052860 DOI: 10.1136/annrheumdis-2016-210390] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/15/2016] [Accepted: 12/17/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate coronary atherosclerosis in patients with psoriatic arthritis (PsA) and control subjects using coronary CT angiography (CCTA). METHODS Ninety consecutive patients with PsA (male: 56(62.2%); 50.3±11.1 years) were recruited. 240 controls (male: 137(57.1%); 49.6±10.7 years) without known cardiovascular (CV) diseases who underwent CCTA due to chest pain and/or multiple CV risk factors were recruited for comparison. RESULTS Patients with PsA and controls were matched in age, gender and traditional CV risk factors (all p>0.2). The prevalence of overall plaque (54(60%)/84(35%), p<0.001), calcified plaque (CP) (29(32%)/40(17%), p=0.002), mixed plaque (MP) (20(22%)/18(8%), p<0.001), non-calcified plaque (NCP) (39(43%)/53(22%), p<0.001) and combined MP/NCP (46(51%)/62(26%), p<0.001) were all significantly higher in patients with PsA. Three-vessel disease was diagnosed in 12(13%) patients with PsA and 7(3%) controls (p<0.001), while obstructive plaques (>50% stenosis) were observed in 8(9%) patients with PsA and 7(3%) controls (p=0.033). After adjusting for traditional CV risk factors, PsA remained an independent explanatory variable for all types of coronary plaques (OR: 2.730 to 4.064, all p<0.001). PsA was also an independent explanatory variable for three-vessel disease (OR: 10.798, p<0.001) and obstructive plaque (3.939, p=0.024). In patients with PsA, disease duration was the only disease-specific characteristic associated with more vulnerable plaques (MP/NCP) in multivariate analysis (1.063, p=0.031). The other independent explanatory variables were age ≥55 years (5.636, p=0.005) and male gender (8.197, p=0.001). CONCLUSIONS Patients with PsA have increased prevalence, burden and severity of coronary atherosclerosis as documented by CCTA. Longer disease duration was independently associated with the presence of vulnerable MP/NCP plaques in patients with PsA. TRIAL REGISTRATION NUMBER NCT02232321.
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Affiliation(s)
- Jiayun Shen
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ka-Tak Wong
- Department of Diagnostic and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Isaac T Cheng
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Qing Shang
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Edmund K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, 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
| | - Emily W Kun
- Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong, Hong Kong
| | - Mei Yan Law
- Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong, Hong Kong
| | - Ronald Yip
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Isaac Yim
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
| | - Shirley Ying
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Martin Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chun-Kwok Wong
- Department of Chemical Pathology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tracy Y Zhu
- Bone Quality and Health Center of the Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jack Jock-Wai Lee
- Division of Biostatistics, The Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Mimi Chang
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, 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, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Polachek A, Touma Z, Anderson M, Eder L. Risk of Cardiovascular Morbidity in Patients With Psoriatic Arthritis: A Meta-Analysis of Observational Studies. Arthritis Care Res (Hoboken) 2016; 69:67-74. [DOI: 10.1002/acr.22926] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/04/2016] [Accepted: 04/19/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Ari Polachek
- University of Toronto, Toronto Western Hospital; Toronto Ontario Canada
| | - Zahi Touma
- University of Toronto, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; Toronto Ontario Canada
| | | | - Lihi Eder
- University of Toronto, Women's College Research Institute, Women's College Hospital; Toronto Ontario Canada
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Lupoli R, Pizzicato P, Scalera A, Ambrosino P, Amato M, Peluso R, Di Minno MND. Impact of body weight on the achievement of minimal disease activity in patients with rheumatic diseases: a systematic review and meta-analysis. Arthritis Res Ther 2016; 18:297. [PMID: 27964760 PMCID: PMC5155390 DOI: 10.1186/s13075-016-1194-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/24/2016] [Indexed: 12/26/2022] Open
Abstract
Background In this study, we evaluated the impact of obesity and/or overweight on the achievement of minimal disease activity (MDA) in patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA) receiving an anti-rheumatic treatment. Obesity can be considered a low-grade, chronic systemic inflammatory disease and some studies suggested that obese patients with rheumatic diseases exhibit a lower rate of low disease activity achievement during treatment with anti-rheumatic drugs. Methods A systematic search was performed in major electronic databases (PubMed, Web of Science, Scopus, Embase) to identify studies reporting MDA achievement in obese and/or overweight patients with RA or PsA and in normal-weight RA or PsA control subjects. Results were expressed as Odds Ratios (ORs) with pertinent 95% Confidence Intervals (95%CIs). Results We included 17 studies (10 on RA and 7 on PsA) comprising a total of 6693 patients (1562 with PsA and 5131 with RA) in the analysis. The MDA achievement rate was significantly lower in obese patients than in normal-weight subjects (OR 0.447, 95% CI 0.346–0.577, p < 0.001, I2 = 62.6%, p < 0.001). Similarly, overweight patients showed a significantly lower prevalence of MDA achievement than normal-weight subjects (OR 0.867, 95% CI 0.757–0.994, p = 0.041, I2 = 64%, p = 0.007). Interestingly, the effect of obesity on MDA was confirmed when we separately analyzed data on patients with RA and patients with PsA. In contrast, when we evaluated the effect of overweight, our results were confirmed for PsA but not for RA. A meta-regression analysis showed that follow-up duration, age, male sex, and treatment duration are covariates significantly affecting the effect of obesity/overweight on MDA achievement. Conclusions The results of our meta-analysis suggest that obesity and overweight reduce the chances to achieve MDA in patients with rheumatic diseases receiving treatment with traditional or biologic disease-modifying antirheumatic drugs. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1194-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roberta Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Paolo Pizzicato
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonella Scalera
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Pasquale Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Manuela Amato
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Rosario Peluso
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Matteo Nicola Dario Di Minno
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
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Ibáñez-Bosch R, Restrepo-Velez J, Medina-Malone M, Garrido-Courel L, Paniagua-Zudaire I, Loza-Cortina E. High prevalence of subclinical atherosclerosis in psoriatic arthritis patients: a study based on carotid ultrasound. Rheumatol Int 2016; 37:107-112. [DOI: 10.1007/s00296-016-3617-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/18/2016] [Indexed: 01/23/2023]
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Juneblad K, Rantapää-Dahlqvist S, Alenius GM. Disease Activity and Increased Risk of Cardiovascular Death among Patients with Psoriatic Arthritis. J Rheumatol 2016; 43:2155-2161. [DOI: 10.3899/jrheum.160070] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 01/22/2023]
Abstract
Objective.Recent studies indicate increased cardiovascular (CV) morbidity and mortality in patients with psoriatic arthritis (PsA), but results are inconsistent. This prompted our investigation of the mortality rate, cause of death, and incidence of acute CV events in patients from northern Sweden with PsA.Methods.Patients with established PsA (464) were included. To calculate standardized mortality ratio (SMR) and standardized incidence ratio (SIR) for CV events, data were extracted from the National Causes of Death Register and the National Inpatient Care Register in Sweden, and compared with the general population. The study period was 1995–2011. To study the effect of inflammatory activity, a composite disease activity index (DAI) was used.Results.The SMR (95% CI) for overall mortality and diseases of the circulatory system (International Classification of Diseases, 10th edition; I00-I99) was 1.22 (0.89–1.63) and 1.64 (1.02–2.52), respectively. In regression analysis, DAI was significantly associated with death (OR 1.99, 95% CI 1.41–2.80) when adjusted for age and sex (p < 0.001), and remained significant after stratifying patients into the 2 major causes of death: diseases of the circulatory system and malignant neoplasms. Peripheral and axial disease was associated with death (OR 4.02, 95% CI 1.84–8.84, p < 0.001) compared with peripheral disease only. The SIR (95% CI) for a CV event (myocardial infarction or stroke) was 0.597 (0.40–0.86); this association was only significant in men.Conclusion.Patients with PsA had a small but significant increase in SMR for death due to diseases of the circulatory system compared with the general population. Among patients, death was associated with DAI, as well as axial involvement in combination with peripheral disease, indicating more aggressive disease phenotypes.
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Carotid plaque and bone density and microarchitecture in psoriatic arthritis: the correlation with soluble ST2. Sci Rep 2016; 6:32116. [PMID: 27554830 PMCID: PMC4995470 DOI: 10.1038/srep32116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/02/2016] [Indexed: 01/04/2023] Open
Abstract
Psoriatic arthritis (PsA) patients have increased risk of both atherosclerosis and osteoporosis. Previous studies revealed that IL-33/ST2 axis may be related to both conditions; however, these associations were never evaluated in a single patients’ group. Here we explored the association among plasma levels of IL-33 and its decoy receptor soluble ST2 (sST2), carotid plaque determined by ultrasound, and volumetric bone mineral density (vBMD)/microstructure of distal radius measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 80 PsA patients (55% male; 53.0 ± 10.1 years). Plasma sST2 levels were significantly higher in 33 (41%) patients with carotid plaques (11.2 ± 4.5 vs 7.7 ± 3.7 ng/ml, P < 0.001). In multivariate analysis, sST2 was an independent explanatory variable associated with carotid plaques (OR = 1.296, 95% CI: [1.091,1.540]; P = 0.003). After adjustment for the osteoporotic risk factors, sST2 was significantly associated with higher cortical porosity (β = 0.184, [0.042,0.325]; P = 0.012) and cortical pore volume (2.247, [0.434,4.060]; P = 0.016); and had a trend to be associated with lower cortical vBMD (−2.918, [−6.111,0.275]; P = 0.073). IL-33 was not associated with carotid plaque or vBMD/microstructure. In conclusion, plasma sST2 levels were independently correlated with both carotid plaque and compromised cortical vBMD/microstructure in PsA patients. IL-33/ST2 axis may be a link between accelerated atherosclerosis and osteoporosis in PsA.
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Gentile M, Peluso R, Di Minno MND, Costa L, Caso F, de Simone B, Iannuzzo G, Scarpa R, Rubba P. Association between small dense LDL and sub-clinical atherosclerosis in patients with psoriatic arthritis. Clin Rheumatol 2016; 35:2023-2029. [PMID: 27411815 DOI: 10.1007/s10067-016-3344-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/16/2016] [Accepted: 06/27/2016] [Indexed: 01/22/2023]
Abstract
Psoriatic arthritis (PsA) is an inflammatory rheumatic disorder occurring in patients with psoriasis. Several studies have shown an association between Psa and traditional atherosclerotic risk factors. We evaluated the relationship between small dense low-density lipoproteins particles (sd-LDL) a risk marker for atherosclerosis, sub-clinical atherosclerosis and PsA in a group of 50 patients with PsA and in 100 controls. Cholesterol, high-density lipoproteins (HDL), low-density lipoproteins (LDL), triglycerides, insulin, homeostasis model assessment (HOMA), Apo B, and sd-LDL have been measured. LDL particle separation was performed and seven LDL subfractions were obtained, LDL score (percentage of sd-LDL) and mean LDL particle size were calculated. PsA patients and control group differ significantly (p < 0.001) in triglycerides values (119.3 ± 52.0 vs 90.7 ± 40.7 mg/dL), Apo B (1.1 ± 0.2 vs 0.9 ± 0.1 g/L), insulin (8.9 ± 4.9 vs 5.8 ± 3.2 mU/L), HOMA (2.2 ± 1.7 vs 1.3 ± 0.8), BMI (27.7 ± 3.3 vs 25.8 ± 3.8). LDL score is significantly higher in PsA as compared to control (9.0 ± 10.7 vs 2.9 ± 4.7 mg/dL); and mean LDL size is significantly lower in PsA than control (268.1 ± 4.6 vs 271.2 ± 2.7 Å). These differences were confirmed when stratifying PsA patients for treatment and for disease activity. LDL score and LDL diameter significantly were correlated with the carotid IMT in patients with PsA. These findings show a novel relationship between LDL score and mean LDL size with PsA diagnosis and with sub-clinical atherosclerosis. Sd-LDL gives potentially useful information in the risk assessment for atherosclerotic disease in PsA patients.
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Affiliation(s)
- Marco Gentile
- Department of Clinical Medicine and Surgery, University Federico II, Edificio 1, Via Pansini 5, 80131, Naples, Italy.
| | - Rosario Peluso
- Department of Clinical Medicine and Surgery, University Federico II, Edificio 1, Via Pansini 5, 80131, Naples, Italy
| | | | - Luisa Costa
- Department of Clinical Medicine and Surgery, University Federico II, Edificio 1, Via Pansini 5, 80131, Naples, Italy.,Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, University Federico II, Edificio 1, Via Pansini 5, 80131, Naples, Italy.,Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Biagio de Simone
- Department of Clinical Medicine and Surgery, University Federico II, Edificio 1, Via Pansini 5, 80131, Naples, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, University Federico II, Edificio 1, Via Pansini 5, 80131, Naples, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery, University Federico II, Edificio 1, Via Pansini 5, 80131, Naples, Italy
| | - Paolo Rubba
- Department of Clinical Medicine and Surgery, University Federico II, Edificio 1, Via Pansini 5, 80131, Naples, Italy
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Garg N, Krishan P, Syngle A. Atherosclerosis in Psoriatic Arthritis: A Multiparametric Analysis Using Imaging Technique and Laboratory Markers of Inflammation and Vascular Function. Int J Angiol 2016; 25:222-228. [PMID: 27867287 DOI: 10.1055/s-0036-1584918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Cardiovascular disease is one of the leading causes of death in psoriatic arthritis (PsA). Pathogenesis of accelerated atherosclerosis in PsA remains to be elucidated. Endothelial dysfunction (ED) often precedes manifesting atherosclerosis. This study aims to assess carotid intima-media thickness (CIMT), a marker of atherosclerosis in PsA, in context of markers of inflammation and vascular function. A cross-sectional study was performed in 18 PsA patients who were compared with 18 controls matched for age and sex. Flow-mediated dilatation (FMD) assessed by AngioDefender (Everist Health, Ann Arbor, MI), endothelial progenitor cells (EPCs) quantified by flow cytometry and CIMT measured ultrasonographically. Inflammatory measures included disease activity score of 28 joints count and disease activity index in psoriatic arthritis. We also assayed markers of inflammation, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), proinflammatory cytokines (interleukin [IL]-1, IL-6, and tumor necrosis factor [TNF]-α), and endothelial dysfunction, including lipids, intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and EPCs. CIMT is significantly higher in PsA patients compared with controls (0.062 ± 0.18 vs. 0.045 ± 0.10 cm, p < 0.01) whereas FMD%, EPCs%, and high-density lipoproteins (HDL) cholesterol are significantly reduced in PsA compared with controls (p < 0.05). Compared with controls, PsA patients had significantly increased concentrations of ESR, CRP, TNF-α, IL-6, ICAM-1, and VCAM-1. In PsA, CIMT positively correlated with IL-6 and ICAM-1 and inversely correlated with FMD, HDL, and EPCs (p < 0.05). In PsA, FMD and CIMT were impaired, indicating endothelial dysfunction and accelerated atherosclerosis, respectively. PsA-related inflammatory mechanisms (TNF-α, IL-6) and markers of vascular function (CRP, ICAM-1, and EPCs) may all be involved in the development of vascular disease in PsA. Cytokine-triggered inflammation upregulates expression of adhesion molecules, depletes EPCs with endothelial dysfunction, and increased CIMT in PsA.
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Affiliation(s)
- Nidhi Garg
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
| | - Pawan Krishan
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
| | - Ashit Syngle
- Cardio Rheuma and Healing Touch City Clinic, Chandigarh and Rheumatologist, Fortis Multispecialty Hospital, Mohali, Punjab, India
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Wu GC, Leng RX, Lu Q, Fan YG, Wang DG, Ye DQ. Subclinical Atherosclerosis in Patients With Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis. Angiology 2016; 68:447-461. [PMID: 27252243 DOI: 10.1177/0003319716652031] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We evaluated the differences in major markers of cardiovascular (CV) risk between inflammatory bowel diseases (IBDs) and controls by a systematic review and a meta-analysis. We searched PubMed, EMBASE, and Cochrane databases for literature comparing CV risk markers in IBDs and controls. The overall mean carotid intima-media thickness (CIMT), flow-mediated dilation (FMD%), and carotid-femoral pulse wave velocity (cfPWV) difference between patients with IBDs and control groups were calculated. Twenty-eight studies were included in the meta-analysis, including 16 studies with data on CIMT, 7 studies reporting FMD%, and 9 studies on cfPWV. Compared to controls, patients with IBDs showed significantly higher CIMT (standardized mean difference [ SMD]: 0.534 mm; 95% confidence interval [CI], 0.230 to 0.838; P = .001), significantly lower FMD% ( SMD, -0.721%; 95% CI, -1.020 to -0.421; P < .0001), and significantly increased cfPWV ( SMD, 0.849; 95% CI, 0.589 to 1.110; P < .0001). When analyzing subgroups with ulcerative colitis and Crohn disease (CD), all results were still significant except CIMT in CD. Our findings support the current evidence for an elevated CV burden in patients with IBD and support the clinical utility of markers of subclinical atherosclerosis in the management of these patients.
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Affiliation(s)
- Guo-Cui Wu
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Rui-Xue Leng
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qi Lu
- 2 Department of Clinical Medicine, The College of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Yin-Guang Fan
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - De-Guang Wang
- 3 Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Dong-Qing Ye
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Abstract
The association between psoriasis and carotid intima-media thickness (CIMT) or impaired flow-mediated dilation (FMD) remains controversial. We aimed to evaluate the extent of subclinical atherosclerosis as measured by CIMT and FMD in patients with psoriasis by conducting a meta-analysis.A systematic literature search was performed using PubMed, Embase, Cochrane databases, China National Knowledge Infrastructure, and VIP databases up to February 2015. Observational studies investigating CIMT or FMD in patients with psoriasis and controls were eligible. Psoriatic patients and controls were at least age- and sex-matched. Random-effects analysis was used to estimate the weighted mean difference (WMD) and 95% confidence interval (CI) between psoriatic patients and controls.A total of 20 studies were identified and analyzed. Meta-analysis showed that psoriatic patients had a significantly thicker CIMT (WMD 0.11 mm; 95% CI 0.08-0.15) and lower FMD (WMD -2.79%; -4.14% to -1.43%) than those in controls. Subgroup analysis indicated that psoriatic arthritis appeared to have less impaired FMD (WMD -2.45%) and thinner CIMT (WMD 0.10 mm). Psoriatic patients with mean age >45 years had much thicker CIMT (WMD 0.13 mm). The impaired FMD (WMD -3.99%) seemed more pronounced in psoriatic patients with mean age <45 years.This meta-analysis suggests that patients with psoriasis are associated with excessive risk of subclinical atherosclerosis. Screening and monitoring CIMT and brachial artery FMD may be recommended to identify a subgroup of psoriatic patients at higher risk for cardiovascular events.
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Affiliation(s)
- Na Fang
- From the Institute of Molecular Biology & Translational Medicine, the Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, PR China
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Ambrosino P, Lupoli R, Tortora A, Cacciapuoti M, Lupoli GA, Tarantino P, Nasto A, Di Minno MND. Cardiovascular risk markers in patients with primary aldosteronism: A systematic review and meta-analysis of literature studies. Int J Cardiol 2016; 208:46-55. [PMID: 26826789 DOI: 10.1016/j.ijcard.2016.01.200] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/08/2016] [Accepted: 01/15/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with primary aldosteronism (PA). We performed a meta-analysis on the impact of PA on major markers of CV risk. METHODS Studies on the relationship between PA and common carotid artery intima-media thickness (CCA-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), pulse-wave velocity (PWV), augmentation index (AIx), and ankle-brachial index (ABI) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. RESULTS 12 case-control studies (445 cases, 472 controls) were included. Compared to subjects with essential hypertension (EH), PA patients showed a higher CCA-IMT (MD: 0.12 mm; 95% CI: 0.09, 0.16; P<0.00001), and a higher aortic-PWV (272 cases and 240 controls, MD: 1.39 m/s; 95% CI: 0.90, 1.87; P<0.00001). In contrast, non-significant differences were found in AIx and AIx normalized to a heart rate of 75 beats per minute (AIx@75). When compared to normotensive subjects, PA patients showed significantly higher CCA-IMT (MD: 0.16 mm; 95% CI: 0.05, 0.27; P=0.004), aortic-PWV (MD: 3.74 m/s; 95% CI: 3.43, 4.05; P<0.00001), AIx@75 (MD: 8.59%; 95% CI: 0.69, 16.50; P=0.03), and a significantly lower FMD (MD: -2.52%; 95% CI: -3.64, -1.40; P<0.0001). Sensitivity and subgroup analyses substantially confirmed our results. Metaregression models showed that male gender, diabetes, and smoking habit impact on the observed results. CONCLUSIONS PA appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings could help establish more specific CV prevention strategies in this clinical setting.
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Affiliation(s)
- Pasquale Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberta Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Anna Tortora
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marianna Cacciapuoti
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gelsy Arianna Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Paolo Tarantino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Aurelio Nasto
- Department of Surgery, Unit of General Surgery and Oncology, Andrea Tortora Hospital, Pagani, Italy
| | - Matteo Nicola Dario Di Minno
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy; Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
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Gossec L, Smolen JS, Ramiro S, de Wit M, Cutolo M, Dougados M, Emery P, Landewé R, Oliver S, Aletaha D, Betteridge N, Braun J, Burmester G, Cañete JD, Damjanov N, FitzGerald O, Haglund E, Helliwell P, Kvien TK, Lories R, Luger T, Maccarone M, Marzo-Ortega H, McGonagle D, McInnes IB, Olivieri I, Pavelka K, Schett G, Sieper J, van den Bosch F, Veale DJ, Wollenhaupt J, Zink A, van der Heijde D. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis 2015; 75:499-510. [PMID: 26644232 DOI: 10.1136/annrheumdis-2015-208337] [Citation(s) in RCA: 620] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/30/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Since the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations. METHODS A systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evidence and strengths of recommendations were allocated. RESULTS The updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for PsA from non-steroidal anti-inflammatory drugs (NSAIDs), to conventional synthetic (csDMARD) and biological (bDMARD) disease-modifying antirheumatic drugs, whatever their mode of action, taking articular and extra-articular manifestations of PsA into account, but focusing on musculoskeletal involvement. The overarching principles address the need for shared decision-making and treatment objectives. The recommendations address csDMARDs as an initial therapy after failure of NSAIDs and local therapy for active disease, followed, if necessary, by a bDMARD or a targeted synthetic DMARD (tsDMARD). The first bDMARD would usually be a tumour necrosis factor (TNF) inhibitor. bDMARDs targeting interleukin (IL)12/23 (ustekinumab) or IL-17 pathways (secukinumab) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor (apremilast) if bDMARDs are inappropriate. If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used. CONCLUSIONS These recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion.
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Affiliation(s)
- L Gossec
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), Paris, France Department of rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - J S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria Second Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - S Ramiro
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M de Wit
- EULAR, representing People with Arthritis/Rheumatism in Europe (PARE), London, UK
| | - M Cutolo
- Research Laboratory and Clinical Division of Rheumatology, Department of Internal Medicine, University of Genova, Viale Benedetto, Italy
| | - M Dougados
- Medicine Faculty, Paris Descartes University, Paris, France Rheumatology B Department, APHP, Cochin Hospital, Paris, France
| | - P Emery
- Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, UK Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - R Landewé
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands Atrium Medical Center, Heerlen, The Netherlands
| | | | - D Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - N Betteridge
- EULAR, representing People with Arthritis/Rheumatism in Europe (PARE), London, UK
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne and Ruhr-Universität Bochum, Herne, Germany
| | - G Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Germany
| | - J D Cañete
- Arthritis Unit, Department of Rheumatology, Hospital Clínic and IDIBAPS, Barcelona, Spain
| | - N Damjanov
- Belgrade University School of Medicine, Belgrade, Serbia
| | - O FitzGerald
- Department of Rheumatology, St. Vincent's University Hospital and Conway Institute, University College Dublin, Dublin, Ireland
| | - E Haglund
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden Sweden and School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
| | - P Helliwell
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
| | - T K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - R Lories
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Belgium Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - T Luger
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - M Maccarone
- A.DI.PSO. (Associazione per la Difesa degli Psoriasici)-PE.Pso.POF (Pan European Psoriasis Patients' Organization Forum), Rome, Italy
| | - H Marzo-Ortega
- Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, UK Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - D McGonagle
- Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, UK Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - I B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - I Olivieri
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - K Pavelka
- Institute and Clinic of Rheumatology Charles University Prague, Czech Republic
| | - G Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - J Sieper
- Department of Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany
| | | | - D J Veale
- Centre for Arthritis and Rheumatic Disease, Dublin Academic Medical Centre, St. Vincent's University Hospital, Dublin, Ireland
| | - J Wollenhaupt
- Schoen Klinik Hamburg, Rheumatology and Clinical Immunology, Hamburg, Germany
| | - A Zink
- Department of Rheumatology and Clinical Immunology, German Rheumatism Research Centre Berlin, Charité-University Medicine Berlin, Germany
| | - D van der Heijde
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
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Di Minno MND, Ambrosino P, Lupoli R, Di Minno A, Tasso M, Peluso R, Tremoli E. Clinical assessment of endothelial function in patients with rheumatoid arthritis: A meta-analysis of literature studies. Eur J Intern Med 2015; 26:835-42. [PMID: 26547241 DOI: 10.1016/j.ejim.2015.10.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/27/2015] [Accepted: 10/21/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with rheumatoid arthritis (RA). Flow-mediated (FMD) and nitrate-mediated dilation (NMD) are considered non-invasive methods to assess endothelial function and surrogate markers of subclinical atherosclerosis. METHODS We performed a systematic review with meta-analysis and meta-regression of literature studies evaluating the impact of RA on FMD and NMD. Studies evaluating the relationship between RA and markers of CV risk (FMD and NMD) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. The random-effect method was used for analyses and results were expressed as mean difference (MD). RESULTS A total of 20 studies (852 RA patients, 836 controls) were included in the final analysis. In detail, 20 studies with data on FMD (852 cases, 836 controls) and 5 studies with data on NMD (207 cases, 147 controls) were analyzed. Compared to controls, RA patients showed a significantly lower FMD (MD: -2.16%; 95% CI: -3.33, -0.98; P=0.0003), with no differences in NMD (MD: -0.41%; 95% CI: -2.89, 2.06; P=0.74). Interestingly, a lower FMD (MD: -2.00%; 95% CI: -3.20, -0.80; P=0.001) and no differences in NMD (P=0.49) were confirmed when excluding data on patients with early-RA. Meta-regression models showed that a more severe inflammatory status was associated with a more significant impairment in FMD. CONCLUSIONS RA patients show impaired FMD, which is currently considered an independent predictor of CV events. The presence of endothelial dysfunction in RA should be taken into account to plan adequate prevention strategies and therapeutic approaches.
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Affiliation(s)
- Matteo Nicola Dario Di Minno
- Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
| | - Pasquale Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberta Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Alessandro Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marco Tasso
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rosario Peluso
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Elena Tremoli
- Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Di Minno MND, Iervolino S, Zincarelli C, Lupoli R, Ambrosino P, Pizzicato P, Di Minno A, Pappone N, Peluso R. Cardiovascular effects of Etanercept in patients with psoriatic arthritis: evidence from the cardiovascular risk in rheumatic diseases database. Expert Opin Drug Saf 2015; 14:1905-13. [DOI: 10.1517/14740338.2015.1111870] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Caso F, Costa L, Del Puente A, Di Minno MND, Lupoli G, Scarpa R, Peluso R. Pharmacological treatment of spondyloarthritis: exploring the effectiveness of nonsteroidal anti-inflammatory drugs, traditional disease-modifying antirheumatic drugs and biological therapies. Ther Adv Chronic Dis 2015; 6:328-38. [PMID: 26568809 PMCID: PMC4622317 DOI: 10.1177/2040622315608647] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Spondyloarthritis represents a heterogeneous group of articular inflammatory diseases that share common genetic, clinical and radiological features. The therapy target of spondyloarthritis relies mainly in improving patients' quality of life, controlling articular inflammation, preventing the structural joints damage and preserving the functional abilities, autonomy and social participation of patients. Among these, traditional disease-modifying antirheumatic drugs have been demonstrated to be effective in the management of peripheral arthritis; moreover, in the last decade, biological therapies have improved the approach to spondyloarthritis. In patients with axial spondyloarthritis, tumor necrosis factor α inhibitors are currently the only effective therapy in patients for whom conventional therapy with nonsteroidal anti-inflammatory drugs has failed. The aim of this review is to summarize the current experience and evidence about the pharmacological approach in spondyloarthritis patients.
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Affiliation(s)
- Francesco Caso
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, and Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy
| | - Antonio Del Puente
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy
| | | | - Gelsy Lupoli
- Department of Clinical Medicine and Surgery, University Federico II Naples, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy
| | - Rosario Peluso
- Rheumatology Research Unit, Department of Clinical Medicine and Surgery, University Federico II - Via Sergio Pansini 5 - 80131 Naples, Italy
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