Active peripheral inflammation is associated with pro-atherogenic lipid profile in psoriatic arthritis

The association between psoriatic arthritis (PsA) disease activity and lipid profiles has not been explored. We studied the association between active peripheral arthritis and/or enthesitis/daclylitis with lipid measurements in PsA.

We conducted a cross-sectional study of PsA patients enrolled in the Consortium of Rheumatology Researchers of North American (CORRONA) registry. Low activity was defined as Clinical Disease Activity Index (CDAI) ≤ 10 without enthesitis or dactylitis. Moderate-to-high peripheral disease activity was defined as CDAI > 10 and/or the presence of enthesitis/dactylitis.

Of the 4672 patients with PsA enrolled in the CORRONA registry from June 2008 to October 2012, 725 (15.5%) had complete data on CDAI and lipid measurements. Of them, 284 (39%) patients had CDAI > 10 and/or enthesitis/dactylitis. Moderate-to-high group included more women and more current smokers. Patients with moderate-to-high disease activity had shorter duration of disease, and were more likely to be on prednisone, but less likely to use tumor necrosis factor (TNF) inhibitors. Moderate-to-high peripheral disease activity was associated with abnormal total cholesterol (TC) (>200mg/dl), odds ratio (OR) = 1.58; 95% CI: (1.11, 2.24); p = 0.01, and abnormal triglycerides (TG) (>150mg/dl), OR = 1.64; 95% CI: (1.16, 2.32); p = 0.005, after adjusting for gender, duration of PsA, smoking, body mass index, diabetes, modified Heath Assessment Questionnaire scores, as well as the following medications: methotrexate, other non-biologic disease modifying anti-rheumatic drugs, prednisone, TNF inhibitors, cholesterol lowering medications, and fish oil. The presence of enthesitis and/or dactylitis, irrespective of CDAI scores, was associated with abnormal TC, OR = 1.64; 95% CI: (1.08, 2.48); p = 0.02.

Our findings suggest an association between peripheral joint inflammation and lipid dysregulation in PsA. Further studies are needed to determine if treating PsA improves lipid profiles and cardiovascular mortality.