Enthesitis and joint erosions are disease traits associated with cardiovascular risk in psoriatic arthritis

To analyze the prevalence of subclinical atherosclerosis (SA), as well as the factors associated with it, in psoriatic arthritis (PsA).

This cross-sectional observational study included 140 consecutive patients with PsA. Systematic COronary Risk Evaluation (SCORE) risk charts and carotid ultrasound (CU) were used to estimate cardiovascular risk (CVR). The presence of plaque and/or a carotid intima-media thickness (cIMT) > 0.9 mm defined SA. Disease features associated with SA were analyzed.

The prevalence of SA in this study was 25%. According to the SCORE charts, 42.8%, 35.7%, and 21.5%, had low, moderate, and high-very high CVR, respectively. The best criterion to define a high CVR (by SCORE plus carotid plaques) corresponded to a cIMT > 0.63 mm (area under the ROC curve 0.75 (0.66-0.82), p < 0.0001). Patients in minimal disease activity (MDA) showed less SA (cIMT > 0.9 mm, 6.2% vs. 30.2% in non-MDA, p < 0.05, and carotid plaques in 23.7% vs. 32.6% in non-MDA). Disease factors associated with SA were age (OR 1.08 (1.03-1.13), p < 0.001), smoking (OR 4.26 (1.44-12.65), p = 0.01), enthesitis (OR 3.76 (1.36-10.40), p = 0.01), and erosive disease (OR 5.23 (1.33-20.50), p = 0.02).

Subclinical atherosclerosis was associated with both classic CVR factors as well as others more linked to the inflammatory nature of this disease. Patients reaching the MDA showed less SA. Cardiovascular risk should be closely monitored in PsA patients who develop enthesitis and/or structural damage. Key Points • Subclinical atherosclerosis is relatively common in psoriatic arthritis. • Patients reaching the minimal disease activity response show less subclinical atherosclerosis. • Patients with enthesitis and/or structural damage are a high-risk population for subclinical atherosclerosis.