Cumulative inflammatory burden is independently associated with increased arterial stiffness in patients with psoriatic arthritis: a prospective study

Abstract

Introduction: The aim of this study was to examine whether the cumulative inflammatory burden is associated with an increase in arterial stiffness in a prospective cohort of psoriatic arthritis (PsA) patients.

Methods: In total, 72 PsA patients were followed for a median of 6.5 years. Cumulative inflammatory burden was represented by the cumulative averages of repeated measures of erythrocyte sedimentation rate (ca-ESR) and C-reactive protein (ca-CRP). Brachial-ankle pulse wave velocity (PWV) was measured at the last visit. We also included 47 healthy controls for PWV assessment.

Results: PWV was significantly higher in PsA patients compared with healthy controls after adjustment for age, gender and body weight (1466±29 cm/s versus 1323±38 cm/s, P=0.008). PsA patients were divided into two groups based on whether their PWV value is ≥1450 cm/s (High PWV group, N=38) or <1450 cm/s (Low PWV group, N=34). The High PWV group had a significantly higher ca-ESR (29 (19 to 44) versus 18 (10 to 32) mm/1st hour, P=0.005) and ca-CRP (0.7 (0.3 to 1.4) versus 0.4 (0.2 to 0.7) mg/dl, P=0.029). Using regression analysis, high ca-ESR (defined as ≥75th percentile: 37 mm/1st hour) was associated with a higher likelihood of being in the High PWV group (odds ratio (OR): 9.455 (1.939 to 46.093), P=0.005, adjusted for baseline clinical and cardiovascular risk factors; and 9.111 (1.875 to 44.275), P=0.006, adjusted for last visit parameters).

Conclusions: Cumulative inflammatory burden, as reflected by ca-ESR, was associated with increased arterial stiffness in PsA patients even after adjustment for cardiovascular risk factors, emphasizing the important role of chronic inflammation in accelerating the development of cardiovascular risks in PsA patients.

Figure 1

Pulse wave velocity (PWV) in control subjects and patients with psoriatic arthritis (PsA). (A) Unadjusted mean in control subjects (n = 47) and all PsA patients (n = 72). (B) Mean adjusted by age, gender and body weight in control subjects and all PsA patients. (C) Mean adjusted by age, gender and body weight in control subjects and PsA patients without hypertension, diabetes or hyperlipidemia (n = 20).

Figure 2

Cumulative inflammatory burden and pulse wave velocity (PWV). Cumulative average of erythrocyte sedimentation rate (ca-ESR) and C-reactive protein (CRP) in the low PWV group (PWV <1,450 cm/s, n = 34) and the high-PWV group (PWV ≥1,450 cm/s, n = 38).