Endothelial dysfunction and risk factors for atherosclerosis in psoriatic arthritis: overview and comparison with rheumatoid arthritis

Abstract

Endothelial dysfunction (ED) is defined as an impairment in the vasodilatory, anti-thrombotic, and anti-inflammatory properties of the cells that make up the lining of blood vessels. ED is considered a key step in the development of atherosclerotic cardiovascular disease. The association between ED and systemic inflammatory diseases is well established. However, the prevalence and clinical significance of ED in psoriatic arthritis (PsA) have been investigated to a lesser extent. This review aims to explore the link between ED and PsA, including ED in macro- and microcirculation, as well as risk factors for its occurrence in PsA and its relationship with atherosclerosis in PsA. Furthermore, the ED in PsA was compared with that of rheumatoid arthritis (RA). Regarding ED in the microcirculation, the coronary flow reserve was found to be significantly reduced in individuals with PsA. The relationship between PsA and macrovascular ED is more pronounced, along with more advanced atherosclerosis detected in patients with PsA. These results are consistent with those obtained in RA studies. On the other hand, arterial stiffness and signs of vascular remodeling were found more frequently in RA than in PsA, with the potential role of efficient anti-TNF treatment in patients with PsA and psoriasis explaining this finding. The impact of ED on cardiovascular diseases and the burden of this risk caused independently by PsA have not yet been precisely established, however, this group of patients requires special attention with regard to cardiovascular events.

Keywords: Arthritis; Atherosclerosis; Endothelium; Psoriatic; Rheumatoid.

Fig. 1

A Comparative analysis of endothelial dysfunction (ED) and subclinical atherosclerosis in psoriatic arthritis (PsA) and rheumatoid arthritis (RA). This figure visualizes the outcomes of endothelial dysfunction and subclinical atherosclerosis tests, comparing PsA with RA. Each disease is distinguished by specific colors for easy identification. An upward arrow indicates results higher than those of healthy controls, signifying elevated levels, while a downward arrow indicates reduced levels. A question mark denotes inconclusive outcomes. The test names are clearly labeled within frames for quick reference. CTP carotid total plaque, CFR coronary flow reserve, PWV pulse wave velocity, CIMT carotid intima media thickness, NFC nailfold capillaroscopy, FMD flow-mediated dilatation, Aix Augmentation Index Creation Details: The figure was designed using Microsoft PowerPoint and Canva (https://www.canva.com/pl_pl/) on February 3, 2024. Online access at https://www.canva.com/design/DAF7vdCJ41s/aCvx1TqqhiFH-V0dLY-lVw/view. Certain illustrations within the figure are adapted from Servier Medical Art (https://smart.servier.com), courtesy of Servier, under a Creative Commons Attribution 3.0 Unported License available at https://creativecommons.org/licenses/by/3.0/