Journal of Clinical & Experimental Dermatology Research
Open Access

Psoriatic Arthritis: The Link between Cardiometabolic Disease and Inflammatory Activity

José Andrés Lorenzo Martín^{* *}Correspondence: José Andrés Lorenzo Martín, Department of Rheumatology, Burgos University Hospital, Burgos, Spain, Email:

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Description

In this manuscript, we focused on the obesity-inflammation relationship and how this link could impact cardiovascular comorbodities. This work is based on two main principles:

• The obesity entails a low-grade systemic inflammation.

• Most of the immune mediated inflammatory diseases (IMIDs) are associated with a higher cardiovascular risk.

TNFα is a key molecule that is involved in both principles. On the one hand, the adipocytes of overweighted individuals are prone to synthesize pro-inflammatory cytokines, such as TNFα, IL-12 and IL-23 [1,2]. On the other hand, TNFα is involved in aterosclerosis pathogeny, but no only this molecule. Acute pase reactants such as CRP and ESR can increase cardiovascular risk [3,4]. Given this relationships, we wanted to know if the treatment choice could impact on cardiometabolic comorbidities, specifically TNFα blockade. At this moment, the evidence about this issue is not clear [5-8].

In our work, we have two main findings. The first of them raises a warning about the value of acute phase reactants in obese patients. We found out that, in our series, BMI and waist circumference are positively associated to higher levels of CRP and ESR, but not necessarily with higher DAPSA scores or not achieving MDA criteria (Supplementary Table 1). This is consistent with previous studies, which reached the same results [9].

The second finding concers the cardiometabolic comorbidities. In our series, there were no differences between those receiving biologic therapies and non-biologic treatment, in terms of metabolic comorbidities. This is probable due to the data collecting protocol. Nevertheless, we found out that the use of biologic therapies were associated to:

• Lower prevalence of MACE (p=0.047; OR: 0.12, CI 95%: 0.01-0.9);

• Lower prevalence of enthesitis (p=0.008; OR 0.3, CI 95%: 0.16-0.56);

• Lower DAPSA score (p=0.03; OR: 0.28, CI 95%: 0.11-0.72);

• Meeting MDA criteria (p=0.001; OR: 3.65, CI 95%: 1.63-8.13);

• Lower/normal levels of CRP (p=0.029; OR: 0.25, CI 95%: 0.07-0.87) and ESR (p=0.024; OR: 0.36, CI 95%: 0.16-0.82).

This highlights the importance of controlling the inflammation in patients suffering from psoriatic arthritis (PsA), as well as other IMIDs. Furthermore, we also must be careful with some features of PsA, since they are associated with higher cardiovascular risk, as we found out in previous studies of our group [10].

Although we didn´t focus on skin manifestations, there are some thoughts that can be useful when facing psoriasis patients. First of all, we must be careful when evaluating CRP and ESR in obese patients. They could be abnormal and not necessarily because of the inflammatory activity of the disease. This also has been observed in other diseases, such as rheumatoid arthritis [9], so it is likely that the in psoriasis it behaves the same way.

The second though is about inflammation and cardiovascular risk. In our series we found out that anti-TNF treatment is associated with a lower cardiovascular risk. This raises some major questions: does biologic therapy achieve a greater inflammation reduction and, thus, a lower cardiovascular risk in patients suffering from IMIDs? Could be justified the use of biologic treatment in patients with higher cardiovascular risk? This is certainly and interesting field of study. And, last of all, we should remember that there are some features of IMIDs that a associated to higher cardiovascular risk. Enthesitis and joint erosions are one of them in psoriatic arthritis.

References

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