Psoriatic Arthritis Linked to Increased Vascular Inflammation, Regardless of Disease Activity

An analysis of positron emission tomography/computed tomography (PET/CT) scan data from patients with psoriatic arthritis is shedding light on the levels of vascular inflammation among this patient population.

Using data from an ongoing phase 3 trial, results of the study, which were presented at the European Congress of Rheumatology (EULAR) 2023 annual meeting, suggest the presence of psoriatic arthritis was associated with a greater level of vascular inflammation than their healthy counterparts, but no association was observed between disease activity and vascular inflammation.

“This evidence suggests that inflammation in PsA is not limited to skin and joints, but also involves the cardiovascular system”, said study presenter Nienke Kleinrensink, MD, of the Department of Internal Medicine and Dermatology at the University Medical Center Utrecht.²

As the emphasis on multidisciplinary care of patients has increased in recent years, so has the interest in the impact of inflammatory disorders, such as psoriatic and rheumatoid arthritis, on cardiovascular risk. Also presented at EULAR 2023 was a study examining the impact of achieving remission with methotrexate or TNF inhibitors on cardiovascular risk. In this study, results indicated achieving remission with either was associated with marked reductions in risk of acute coronary syndrome, with this risk attenuation returning relative risk to similar levels as healthy controls.³

Citing an interest in evaluating whether vascular inflammation is elevated in patients with psoriatic arthritis, investigators designed the current study as an analysis of patient data from the ongoing TOFA PREDICT trial. Led by Kleinrensink, TOFA PREDICT is an investigator-initiated, phase III, multicenter, open-label, four-arm randomized controlled trial launched with the intent of exploring the clinical, molecular, and imaging parameters of 160 patients with psoriatic arthritis. Per trial protocol, clinical data, biosamples, and imaging data were collected at baseline, 4 weeks, 16 weeks, at treatment failure, and 52 weeks.¹

From the trial, investigators obtained information related to a cohort of 75 patients with active peripheral arthritis, which was defined as having 2 or more tender and swollen joints. For the purpose of analysis, investigators used a retrospective group of 40 patients with melanoma without distant metastases and not receiving immunotherapy to serve as the control group for the study. Baseline analysis indicated there were no significant differences observed between psoriatic arthritis patients and those in the control group in regard to age, mean arterial pressure, and history of cardiovascular disease. However, investigators noted patients with psoriatic arthritis had a greater mean BMI than their counterparts in the control group.¹

The primary outcome of interest was aortic vascular inflammation, which investigators measured using target-to-background ratios (TBR) on PET/CT scans. Investigators noted vascular inflammation was compared between psoriatic arthritis patients and controls using univariate analysis with an unpaired t-test with equal variances. Investigators also noted a multiple linear regression analysis was performed with the intent of exploring the association of clinic parameters of disease activity with vascular inflammation using Spearman’s correlation coefficient.¹

Upon analysis, results indicated vascular information was greater among patients with psoriatic arthritis than among those in the control group (mean TBR for entire aorta respectively 1.53±0.15 and 1.42±0.13; P < .001). Further analysis suggested this apparent association remained significant even after adjustment for gender, age, body mass index, and mean arterial pressure (P = .002). Investigators pointed out there were no associations observed between vascular inflammation and disease-related parameters among patients with psoriatic arthritis.¹

References:

1. Kleinrensink, NJ, Foppen W, Seddiqi N, et al. INCREASED VASCULAR INFLAMMATION ON PET-CT IN PSORIATIC ARTHRITIS PATIENTS IN COMPARISON WITH HEALTHY CONTROLS. Paper presented at: European Congress of Rheumatology (EULAR) 2023. Milan, Italy. May 31 – June 3, 2023.
2. EULAR 2023: CV Risk in Psoriatic Arthritis. EULAR Press Releases. May 31, 2023. Accessed May 31, 2023. https://www.eular.org/document/share/647/c55d1afa-d5a1-406a-9760-79e165afe912.
3. Campbell P. Achieving remission with methotrexate or TNFI linked to lower CV risk in rheumatoid arthritis. HCP Live. May 31, 2023. Accessed May 31, 2023. https://www.hcplive.com/view/achieving-remission-with-methotrexate-or-tnfi-linked-to-lower-cv-risk-in-rheumatoid-arthritis.