Distinct Cardiac Profiles in Psoriatic Arthritis and Rheumatoid Arthritis: Insights from Echocardiographic Findings

Cardiovascular disease contributes to morbidity and mortality in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Systemic inflammation drives risk in RA, while PsA may involve additional immune-metabolic mechanisms, potentially resulting in distinct cardiac phenotypes. Comparative data on subclinical cardiac involvement are limited.

To compare subclinical cardiac abnormalities in RA and PsA using transthoracic echocardiography and identify disease-specific factors associated with cardiac changes.

We conducted a cross-sectional, single-centre study of 92 RA and 78 PsA patients.

age >18 years and fulfilment of 2010 ACR/EULAR (RA) or CASPAR (PsA) criteria. Patients with known cardiac disease or poor imaging quality were excluded. Clinical data included demographics, disease duration, cardiovascular risk factors, and treatments. Disease activity was assessed using DAS28-CRP in RA and DAPSA in PsA. Echocardiography assessed ventricular function, diastolic parameters, pulmonary pressures, valvular abnormalities, and pericardial effusion.

RA patients were older (60.9±13.5 vs 55.2±12.5 years, p=0.006) and had higher BMI (26.0±6.4 vs 24.0±2.8 kg/m², p=0.011). PsA patients had more hypertension (55% vs 39%, p=0.037) and higher biologic/tsDMARD exposure (97% vs 79%, p<0.001). Mean DAPSA in PsA was 21.8±7.3, indicating predominantly moderate disease activity. Compared with RA, PsA patients showed lower tricuspid annular plane systolic excursion (TAPSE )(19.2±1.8 vs 20.7±1.8 mm, p<0.001), higher left atrial volume index (34.7±3.4 vs 33.3±3.5 mL/m², p=0.009), higher prevalence of pericardial effusion (49% vs 23%, p<0.001), and any cardiac abnormality (72% vs 38%, p<0.001). Multivariable analysis identified PsA as independently associated with left ventricular hypertrophy, reduced TAPSE, reduced ejection fraction (EF), pericardial effusion, and overall cardiac abnormalities.

PsA is associated with a higher burden of subclinical cardiac abnormalities than RA, involving both ventricles and the pericardium, after adjustment for measured traditional cardiovascular risk factors, although residual confounding cannot be excluded. These hypothesis-generating findings support consideration of disease-specific cardiovascular monitoring in PsA.