Vascular inflammation may be characteristic of PsA

The comparison of the aortas of patients with psoriatic arthritis (PsA) with those of healthy controls revealed increased vascular inflammation in PsA. PET/CT scan results showed significant differences in the target-to-background ratio (TBR), even when adjusted for cardiovascular risk factors.

“As we know, patients with PsA are at increased risk of developing cardiovascular disease, and these PsA patients also have increased traditional risk factors, such as diabetes, obesity, or smoking. But this does not fully explain the elevated cardiovascular risk in the PsA population,” Dr Nienke Kleinrensink (UMC Utrecht, the Netherlands) explained the motivation for their research [1]. The retrospective Dutch study investigated whether inflammation in patients with PsA may also be present within the vascular system. As means of vascular inflammation determination, 18F-FDG PET/CTs with TBR of the aorta were used, a method that has been determined to be a reliable and reproducible measure [2,3].

The analysis included 75 PsA patients with active peripheral arthritis from an ongoing clinical trial (EudraCT 2017- 003900-28) with a median age of 53, a median swollen joint count of 3, and a mean affected body surface area of 1 [1]. This cohort was compared with a control group of 40 melanoma patients without distant metastases, who neither had auto-immune disease nor were treated with checkpoint inhibitors. “We found no difference in age, blood pressure, or gender, but patients with PsA had a slightly higher BMI than the control group,” Dr Kleinrensink commented on the baseline characteristics. Both groups comprised about 57% of men, and around 15% had prior cardiovascular disease.

The results showed significantly increased vascular inflammation in PsA versus controls, not only when evaluating the entire aorta (P≤0.001) but also in its 5 different sub-segments. These findings remained significant after a multivariate analysis that corrected for traditional cardiovascular risk factors, including age, sex, BMI, and mean arterial pressure.

“We also measured clinical measures of disease activity, such as tender joints count, swollen joints count, enthesitis index, BSA affected psoriasis, and inflammation parameters, but these were not associated with vascular inflammation assessed on PET/CT,” Dr Kleinrensink informed.

In her summary, she said that the study confirms that there is indeed systemic inflammation going on in PsA. “It would be interesting for future studies to assess the effect of PsA treatment on vascular inflammation,” Dr Kleinrensik concluded.

1. Kleinrensink NJ, et Increased vascular inflammation on PET-CT in psoriatic arthritis patients in comparison with healthy controls. OP0026, EULAR 2023, 31 May–3 June, Milan, Italy.
2. Rudd JHF, et J Am Coll Cardiol. 2007;50:892-6.
3. Bucerius J, et Eur J Nucl Med Mol Imaging. 2016;43:780-92.

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Posted on 31 July 202331 July 2023