PREVALENCE OF METABOLIC SYNDROME IN PATIENTS WITH PSORIATIC ARTHRITIS: ITS ASSOCIATION WITH INFLAMMATION AND SUBCLINICAL ATHEROSCLEROSIS

Metabolic syndrome (MS) is a cluster of metabolic disorders giving rise to atherosclerotic  cardiovascular diseases (CVD). The combination  of inflammatory activity and a high spread of traditional  risk factors (RF) for CVD in patients with psoriatic arthritis (PsA) permits them to be referred to as a higher cardiovascular risk group as compared to the general population.

Objective: to estimate the spread of MS and its association with inflammation and subclinical atherosclerosis in patients with PsA.

Subjects and methods. This investigation enrolled 128 patients with PsA (61.7% women and 38.3% men); their median age was 43 [34; 49.5] years; the duration of PsA and psoriasis – 7 [3; 13] and 15 [6; 26] years, respectively). There was a preponderance of patients with moderate (3.7 ≥ DAS > 2.4) and high (DAS > 3.7) disease activity: 33 (25.8%) and 74 (57.8%), respectively. MS was diagnosed on the basis of the 2011 National  Guidelines of the Russian Cardiology Society for Cardiovascular Prevention.  All the patients underwent carotid Doppler ultrasound (CDU) for the diagnosis of subclinical atherosclerosis.

Results and discussion. MS was diagnosed in 49 (38.3%) patients with PsA. The most common  MS criteria were abdominal  obesity in 72 (56.3%) and dyslipidemia [an elevation of low-density lipoproteins (LDL)  level in 101 (78.9%), and a decrease in high-density lipoproteins (HDL)  level in 65 (50.8)]. Hypertension was diagnosed in 32 (25%). 65 (50.8%) patients were found to have subclinical atherosclerosis,  as evidenced by CDU.

The patients with MS were older than those without this condition  (46 [43; 52] and 39 [31; 46] years, respectively; p < 0.0001). These groups did not differ in PsA duration (15 [7; 29] and 15 [5.5; 25] years respectively; p = 0.47). The patients with MS had higher DAS values (4.4 [3.2; 5.6] and 3.6 [2.5; 4.7], respectively; p = 0.02); mean intima media thickness (IMT)  (0.78 [0.72; 0.86] and 0.73 [0.66; 0.77] mm; p < 0.0001) and maximal IMT (0.94 [0.84; 1.03] and 0.84 [0.75; 0.94] mm; p < 0.01). They were found to have significantly more often signs of subclinical carotid atherosclerosis than those without MS (33 (67.3%) and 32 (40.5%) patients, respectively; p = 0.003).

There was a statistically significant relationship between IMT and RF for CVD (MS components, such as waist circumference  (R = 0.41; p <0.0001), systolic blood pressure (R = 0.41; p < 0.0001), LDL (R = 0.44; p < 0.0001), and triglycerides (R = 0.36; p < 0.0001). There was also a correlation between IMT and PsA duration (R = 0.18; p < 0.03).

Conclusion. Thus, the patients with PsA had a high prevalence of MS that was detected in almost 40% of them. There was a relationship of PsA activity to MS. In the PsA patients with MS, IMT was greater than in those without MS. An association was established between IMT and traditional  RF for CVD (MS components), PsA duration,  suggesting that both traditional  RF for CVD and PsA duration may affect the development process of CVD in patients with PsA.

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