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. 2026 Jan 11:77:152923.
doi: 10.1016/j.semarthrit.2026.152923. Online ahead of print.

Disease activity and hyperuricemia predict the development of cardiovascular events in patients with Psoriatic Arthritis: results of the 10-year prospective evaluation in the CARMA cohort

Javier Llorca  1 , Iván Ferraz-Amaro  2 , María José Moreno-Martínez  3 , Zulema Plaza  4 , Fernando Sánchez-Alonso  5 , Manuel José Moreno-Ramos  6 , Carmen García-Gómez  7 , Santos Castañeda  8 , Carlos González-Juanatey  9 , Miguel Ángel González-Gay  10 ; CARMA Project Collaborative Group
Collaborators, Affiliations
Free article

Disease activity and hyperuricemia predict the development of cardiovascular events in patients with Psoriatic Arthritis: results of the 10-year prospective evaluation in the CARMA cohort

Javier Llorca et al. Semin Arthritis Rheum. .
Free article

Abstract

Objective: To identify predictors of cardiovascular (CV) events in psoriatic arthritis (PsA) patients from the CARdiovascular in RheuMAtology (CARMA) project during 10 years of prospective follow-up.

Methods: Between July 2010 and January 2012, 725 PsA patients were enrolled from 67 Spanish hospitals. Analyses focused on 682 patients without prior CV events at baseline. At 10-year follow-up, CV event occurrence, patient-years, and linearized event rates were evaluated. Cox regression analyses were performed, both crude and adjusted for the PREVENT-CVD score.

Results: Over 6397 patient-years, 85 patients (12.46%) experienced CV events, yielding a rate of 1.33 per 100 patient-years. Patients with CV events were older (67.1 ± 11.1 vs. 56.7 ± 11.8 years, p < 0.001), more often male (68.2% vs. 51.9%, p = 0.005), and had higher frequencies of hypertension (60.0% vs. 21.8%, p < 0.001), diabetes (18.8% vs. 6.0%, p = 0.001), and dyslipidemia (56.5% vs. 29.8%, p < 0.001). They also showed greater abdominal perimeter and body mass index (p < 0.05 for both). After adjusting for PREVENT-CVD, the highest tertile of DAS28-ESR remained a significant predictor of CV events (HR 1.79; 95%CI: 1.03-3.14; p = 0.04). Urate in the highest tertile was also independently associated in the crude model (HR 1.88; 95%CI: 1.11-3.20; p = 0.02). When stratified (<6.5, 6.5-8.9, and ≥9.0 mg/dl), urate≥9.0 mg/dl was also associated with increased risk of CV events in the adjusted model (HR 3.50; 95%CI: 1.10-11.2; p = 0.02). While HAQ score in the third tertile was associated with increased CV risk in the crude analysis (HR 1.70; p = 0.04), this association did not persist after adjustment.

Conclusions: Disease activity and elevated urate levels independently predict CV events in PsA, highlighting their value as markers of CV risk beyond traditional factors captured by the PREVENT-CVD score.

Keywords: Cardiovascular risk; DAS28-ESR; Disease activity; PREVENT; Psoriatic arthritis; Urate.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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