J Rheumatol. 2010 37 (7) :1386-94: (ISSN: 0315-162X)

Cardiovascular disease and risk factors in patients with
psoriasis and psoriatic arthritis.

J Rheumatol. 2010; 37(7):1386-94 (ISSN: 0315-162X)
Tobin AM; Veale DJ; Fitzgerald O; Rogers S; Collins P; O'Shea D; Kirby B
Cardiovascular risk factors in psoriatic and rheumatoid

arthritis].
Ter Arkh. 2011; 83(5):20-4 (ISSN: 0040-3660)
Rebrov AP; Nikitina NM; Gaĭdukova IZ
AIM: To study the role of conventional and new factors of cardiovascular risk in development
of atherosclerosis in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PA).
MATERIAL AND METHODS: Sixty patients with psoriatic arthritis, 414 RA patients and 79
healthy controls entered the trial. All of them had no manifestations of cardiovascular
diseases. Screening was made of the leading risk factors of cardiovascular diseases and
cardiovascular complications, thickness of the complex intima-media (TIM) of the carotid
arteries, vascular wall stiffness were measured, vasoregulatory function of the endothelium,
markers of endothelial damage were examined.
RESULTS: Patients with psoriatic and rheumatoid arthritis were found to have increased TIM
of the carotid arteries, high incidence of atherosclerotic plaques, increased stiffness, damage
of the vascular wall, affected endothelial vasoregulation. These alterations were associated
with high arthritis activity, systemic manifestations, seropositivity by rheumatoid factor (in
RA), presence of entesitis, uveitis and dactilitis (in psoriatic arthritis), dislipidemia, arterial
hypertension (AH).
CONCLUSION: To determine cardiovascular risk in patients with arthritis, it is necessary to

consider not only standard risk factors (dislipidemia and AH), but also severity of systemic
inflammation, arterial stiffness, endothelial damage and ability of the vascular wall to relax
reflecting endothelial dysfunction.
Effects of anti-TNF therapy on glucose metabolism in

patients with ankylosing spondylitis, psoriatic arthritis or
juvenile idiopathic arthritis.
Biologicals. 2010; 38(5):567-9 (ISSN: 1095-8320)
da Silva BS; Bonfá E; de Moraes JC; Saad CG; Ribeiro AC; Gonçalves CR; de Carvalho JF
Department of Biomedicine, City University of São Paulo, São Paulo, Brazil.
The objective of this study was to evaluate the influence of anti-tumor necrosis factor (anti-
TNF) in juvenile idiopathic arthritis (JIA), ankylosing spondylitis (AS) or psoriatic arthritis
(PsA). Sixty-two patients were investigated: 7 JIA; 37 AS; and 18 PsA. Caucasian race
accounted for 79% and 29% were female. Mean age was 40.4 +/- 12.6 years. None of the
patients had a history of diabetes, and none had used oral hypoglycemic agents or insulin.
Treatment was with adalimumab, infliximab and etanercept. Glucose, inflammatory markers
and prednisone dose were assessed at baseline, as well as after three and six months of
treatment. The mean erythrocyte sedimentation rate was significantly lower at three months
and six months than at baseline (13.7 +/- 18.0 and 18 +/- 22.5 vs. 27.9 +/- 23.4 mm; p =
0.001). At baseline, three months and six months, we found the following: mean C-reactive
protein levels were comparable (22.1 +/- 22.7, 14.5 +/- 30.7 and 16.0 +/- 23.8 mg/L,
respectively; p = 0.26); mean glucose levels remained unchanged (90.8 +/- 22.2 mg/dl, 89.5
+/- 14.6 mg/dl and 89.8 +/- 13.6 mg/dl, respectively; p = 0.91); and mean prednisone doses
were low and stable (3.9 +/- 4.9 mg/day, 3.7 +/- 4.8 mg/day and 2.6 +/- 4.0 mg/day,
respectively; p = 0.23). During the first six months of treatment, anti-TNF therapy does not
seem to influence glucose metabolism in JIA, AS or PsA.
Risk of diabetes among patients with rheumatoid arthritis,

psoriatic arthritis and psoriasis.
Ann Rheum Dis. 2010; 69(12):2114-7 (ISSN: 1468-2060)
Solomon DH; Love TJ; Canning C; Schneeweiss S
Division of Rheumatology, Department of Medicine, Boston, MA 02115, USA.
dsolomon@partners.org
OBJECTIVE: To examine the risk of diabetes mellitus (DM) among subjects with rheumatoid
arthritis (RA), psoriatic arthritis or psoriasis (PsA/PsO), compared with non-rheumatic
controls.
METHODS: Study cohorts were assembled using linked healthcare utilisation data from
British Columbia. All people with at least two diagnoses of RA or PsA/PsO were included and
compared with a cohort of people without any known rheumatic disease. The outcome of
interest was a diagnosis of new-onset DM, as defined by initiation of an antidiabetic drug.
Incidence rates (IRs) per 1000 person-years and IR ratios were calculated and Cox regression
models were constructed to determine the hazard ratio (HR) for diabetes by age, gender,
systemic immunosuppressive drug and glucocorticoid use.
RESULTS: The study cohort comprised 48 718 subjects with RA, 40 346 with PsA/PsO and
442 033 without any rheumatic disease. The IR for DM among subjects with RA was 8.6 per
1000 person-years (95% CI 8.5 to 8.7), PsA/PsO 8.2 (95% CI 8.1 to 8.3) and for non-
rheumatic controls 5.8 (95% CI 5.8 to 5.8). The adjusted HR for RA compared with non-
rheumatic controls was 1.5 (95% CI 1.4 to 1.5) and 1.4 (95% CI 1.3 to 1.5) for PsA/PsO.
CONCLUSIONS: RA and PsA/PsO appear to be associated with an increased risk of DM.

The ability of potent antirheumatic treatments to reverse this trend warrants study.
Cardiovascular comorbidities in psoriasis and psoriatic

arthritis: pathogenesis, consequences for patient
management, and future research agenda: a report from the
GRAPPA 2009 annual meeting.
Boehncke WH; Gladman DD; Chandran V
Department of Dermatology, Johann Wolfgang Goethe-University, Frankfurt am Main,
Germany. boehncke@em.uni-frankfurt.de
Psoriasis is often associated with other diseases, substantially adding to the patient's burden of
disease. Recent epidemiologic studies have demonstrated an increased cardiovascular
morbidity among patients with psoriasis and psoriatic arthritis (PsA), which contributes to
their reduced life expectancy. At the meeting of the Group for Research and Assessment of
Psoriasis and Psoriatic Arthritis (GRAPPA) adjacent to the International Federation of
Psoriasis Associations (IFPA) congress, members discussed the pathogenetic aspects of this
association and resulting consequences for the management of patients with psoriasis and
PsA. A future research agenda was considered.
Coronary flow reserve and asymmetric dimethylarginine

levels: new measurements for identifying subclinical
atherosclerosis in patients with psoriatic arthritis.
Atzeni F; Sarzi-Puttini P; Sitia S; Tomasoni L; Gianturco L; Battellino M; Boccassini L; De
Gennaro Colonna V; Marchesoni A; Turiel M
Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary
University of London, London, UK. atzenifabiola@hotmail.com
OBJECTIVE: To identify the presence of subclinical atherosclerosis in patients with psoriatic

arthritis (PsA) and healthy controls using intima-media thickness (IMT), coronary flow
reserve (CFR), and the plasma concentration of asymmetric dimethylarginine (ADMA), to
evaluate the correlations among ADMA, IMT, and CFR.
METHODS: The study involved 22 patients who fulfilled the ClASsification of Psoriatic
ARthritis study group criteria for PsA and a cohort of 35 healthy controls with no history or
current signs of coronary artery disease (CAD). Common carotid IMT was measured using
high-resolution B-mode ultrasonography. Dipyridamole transthoracic stress echocardiography
was used to evaluate CFR. Blood samples were obtained to assess ADMA levels. The clinical
manifestations were recorded. All patients were treated with disease-modifying antirheumatic
drug, but none had received any biological or steroid therapy.
RESULTS: Plasma ADMA levels were significantly higher in the patients with PsA (0.71 ±
0.07 μmol/l vs 0.48 ± 0.07 μmol/l; p = 0.00) and CFR was significantly reduced in that group
(2.86 ± 0.70 vs 3.3 ± 0.43; p < 0.01) compared to controls. Common carotid IMT was greater
in the patients with PsA, but the difference was not significant (0.64 ± 0.26 mm vs 0.62 ± 0.5
mm; p = 0.65). There was a significant correlation between CFR and plasma ADMA levels in
the PsA group (R = 0.28; p < 0.01), but no correlation between plasma ADMA levels and IMT
(R = 0.02; p = 0.32), Disease Activity Score 28 (p = 0.52), or Psoriasis Area and Severity
Index (p = 0.98).
CONCLUSION: Our patients with PsA showed a profile of subclinical atherosclerosis.

ADMA may be a useful marker of endothelial dysfunction in PsA.
Cardiovascular mortality in psoriasis and psoriatic arthritis:

epidemiology, pathomechanisms, therapeutic implications,
and perspectives.
Curr Rheumatol Rep. 2012; 14(4):343-8 (ISSN: 1534-6307)
Boehncke WH; Boehncke S
Department of Dermatology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7,
60590 Frankfurt am Main, Germany. boehncke@em.uni-frankfurt.de
Psoriasis and psoriatic arthritis are associated with an increased cardiovascular mortality.
Although the underlying pathogenesis is not yet fully understood, it is clear that these
seemingly organ-specific disorders cause a systemic inflammatory burden as mirrored by
elevated biomarkers in the patients' blood. Emerging evidence points toward insulin resistance
and endothelial dysfunction as direct consequences; these in turn drive the process of
atherosclerosis. As psoriasis and psoriatic arthritis therefore represent cardiovascular risk
factors, they must be taken into account by primary care physicians when defining treatment
goals for the comorbidities of the respective patients (e.g., arterial hypertension or
dyslipidemia). Secondary and tertiary care physicians need to consider a more comprehensive
treatment approach, including aspects of lifestyle intervention. Finally, effective long-term
anti-inflammatory, disease-modifying therapy may contribute to reducing patients'
cardiovascular risk.
Comorbidities of psoriatic arthritis -- metabolic syndrome

and prevention: a report from the GRAPPA 2010 annual
meeting.
Raychaudhuri SP
Veterans Affairs Sacramento Medical Center, University of California Davis, School of
Medicine, Division of Rheumatology, Allergy and Clinical Immunology, Davis, California,
USA. sraychaudhuri@ucdavis.edu
Psoriatic arthritis (PsA) is associated with serious comorbidities such as increased

cardiovascular risk, hypertension, depression, and reduced quality of life. Patients with
psoriasis have been observed to have an increased incidence of metabolic syndrome compared
with the general population; recently, this has also been observed in patients with PsA. This
review focuses on the comorbidities associated with PsA, with an emphasis on risks of
coronary artery disease and metabolic syndrome. We also discuss the development of a
comprehensive approach for the management of comorbidities of PsA. The review
summarizes a presentation at the 2010 annual meeting of GRAPPA (Group for Research and
Assessment of Psoriasis and Psoriatic Arthritis).
Update on biomarkers in psoriatic arthritis: a report from the

GRAPPA 2010 annual meeting.
Fitzgerald O; Chandran V
Department of Rheumatology, St Vincent’s University Hospital and Conway Institute,
University College Dublin, Dublin, Ireland. oliver.fitzgerald@ucd.ie
Biomarkers may be used to screen patients with psoriasis for psoriatic arthritis (PsA) and to
assess disease activity and severity. Candidate biomarkers should fulfil the key features of the
OMERACT (Outcome Measures in Rheumatology) filter, that is, truth, discrimination, and
feasibility. A number of biomarkers are currently being investigated in psoriatic disease for
important clinical outcomes. Serum high sensitivity C-reactive protein, cartilage oligomeric
matrix protein, interleukin 6 (IL-6), osteoprotegerin, matrix metalloprotease-3 (MMP-3), and
the ratio of C-propeptide of type II collagen (CPII) to collagen fragment neoepitopes Col2-3/4
(long mono) (C2C) show promise as serum biomarkers that distinguish subjects with PsA
from those with psoriasis alone. Serum MMP-3 and melanoma inhibitory activity, synovial
fluid IL-1, IL-1 receptor-α, IL-6, IL-8, and chemokine CCL3 and synovial tissue CD3-
positive T cells may prove useful as biomarkers of PsA activity. Circulating osteoclast
precursors, Dickkopf-1, macrophage colony stimulating factor, receptor activator of nuclear
factor-κB ligand, and bone alkaline phosphatase are strong candidates as biomarkers of
radiographic change. Prospective studies to identify biomarkers for psoriatic disease are high
on the research agenda of the Group for Research and Assessment of Psoriasis and PsA.
The association between smoking and the development of

psoriatic arthritis among psoriasis patients.
Eder L; Shanmugarajah S; Thavaneswaran A; Chandran V; Rosen CF; Cook RJ; Gladman DD
Psoriatic Arthritis Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto
Western Hospital, University of Toronto, ON, Canada.
AIM: To investigate the association between smoking and psoriatic arthritis (PsA) among
patients with psoriasis and its interaction with the HLA-C*06 allele.
METHODS: In this exploratory case-control study, smoking status was determined at the time
of the diagnosis of arthritis for PsA patients and at their first study visit for psoriasis patients,
when they were confirmed not to have PsA. The proportions of patients exposed to smoking
were compared in patients with PsA to those with psoriasis alone. A logistic regression model
was constructed to test the independent association of smoking and PsA after adjusting for
potential confounders. The statistical interaction between HLA-C*06 and smoking was tested
through a regression model.
RESULTS: The proportions of current and past smokers were higher in the psoriasis group
compared with the PsA group (30.2% vs 23.4% and 26.7% vs 22.3%, p=0.001, respectively).
On multivariate analysis being a current smoker versus a lifetime non-smoker remained
inversely associated with PsA (OR 0.57, p=0.002), while past smoker versus lifetime non-
smoker status was no longer significant. In a subgroup analysis, smoking remained inversely
associated with PsA only among patients who were HLA-C*06 negative. Regression analysis
revealed that the interaction between smoking status (ever smoked vs lifetime non-smoker)
and HLA-C*06 was statistically significant (p=0.01).
CONCLUSION: Smoking may be inversely associated with PsA among psoriasis patients.
This association is not present among HLA-C*06-positive individuals.
[Subclinical atherosclerosis in patients with psoriatic

arthritis: a case-control study. Preliminary data]
Reumatismo. 2009; 61(4):298-305 (ISSN: 0048-7449)
Contessa C; Ramonda R; Lo Nigro A; Modesti V; Lorenzin M; Puato M; Zanon M; Balbi G;
Doria A; Punzi L
Dipartimento di Medicina Clinica e Sperimentale, Università di Padova, Italia.
OBJECTIVE: The aim of this study was to evaluate the prevalence of subclinical
atherosclerosis in patients with psoriatic arthritis (PsA), correlated with some traditional risk
factors of atherosclerosis and with PsA-related disease factors. METHODS: Forty-one
patients and 41 healthy subjects were evaluated for intima-media thickness (IMT) and flow-
mediated dilation (FMD), using carotid duplex scanning. IMT values were expressed like
IMT mean (cumulative mean of all the IMT mean) and M-MAX (cumulative mean of all the
higher IMT). Subclinical atherosclerosis markers were correlated with age, body mass index
(BMI) and blood pressure in both groups, with duration of arthritis, duration of psoriasis,
tender and swollen joints, BASDAI (Bath Ankylosing Spondylitis Disease Activity Index),
BASFI (Bath Ankylosing Spondylitis Functional Index), erythrocyte sedimentation rate (ESR)
and C-reactive protein (CRP) in patients. RESULTS: IMT mean and M-MAX were both
higher in PsA patients compared with controls (0.7+/-0.15 vs 0.62+/-0.09 mm; p<0.01 and
0.86+/-0.21 vs. 0.74+/-0.13 mm; p<0.01 respectively). FMD was smaller in patients than in
controls (5.9+/-2 vs 7.5+/-2.8%; p<0.01). Univariate analysis showed a correlation between
IMT mean and SBP (r=0.217; p=0.05) and a correlation between M-MAX and age (r=0.392;
p<0.001), BMI (r=0.252; p<0.05), SBP (r=0.446; p<0.001) in both groups. In PsA patients M-
MAX resulted correlated with ESR (r=0.338; p<0.05) and BASDAI (r=0.322; p<0.05).
CONCLUSIONS: PsA patients exhibited endothelial dysfunctions which is an early marker of
subclinical atherosclerosis, as well as an higher IMT. An interesting correlation between M-
MAX and PsA activity index (ESR and BASDAI) was found.
Atherosclerosis in psoriatic arthritis.

Autoimmun Rev. 2011; 10(12):773-8 (ISSN: 1873-0183)
Ramonda R; Lo Nigro A; Modesti V; Nalotto L; Musacchio E; Iaccarino L; Punzi L; Doria A
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of
Padova, Padova, Italy.
The atherosclerotic process is accelerated in several autoimmune rheumatic diseases. Effector

cells of innate and adaptive immunity along with pro-inflammatory cytokines and other
immune mediators are found in atherosclerotic lesions, where they play an important role in
induction, progression and rupture of plaques. Psoriatic arthritis (PsA) is a chronic
inflammatory disease, characterized by arthritis, enthesitis, dactilytis, osteitis, and axial
involvement, along with skin manifestations. PsA is frequently associated with obesity,
diabetes, dyslipidemia, hypertension, accelerated atherosclerosis and with increased
cardiovascular morbidity and mortality. Disease-specific and traditional risk factors seem to
account for the atherosclerotic burden in PsA patients. Some immunological factors which are
involved in PsA can also contribute to atherosclerosis including C reactive protein (CRP),
TNF-α, IFN-γ, IL-1, Il 6, IL23, and Th17.
Psoriatic arthritis is associated with increased arterial

stiffness in the absence of known cardiovascular risk
factors: a case control study.
Clin Rheumatol. 2012; 31(4):711-5 (ISSN: 1434-9949)
Costa L; Caso F; D'Elia L; Atteno M; Peluso R; Del Puente A; Strazzullo P; Scarpa R
Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University
Federico II, Naples, Italy.
The objective of the study was the evaluation of arterial stiffness, a cardiovascular risk factor,
in patients with psoriatic arthritis (PsA). Twenty PsA patients classified on the basis of the
CASPAR criteria (M/W, 14/6; mean age, 38.6 years; range, 22-53), attending our out-patient
clinic, and 20 healthy control subjects (M/W, 14/6; mean age, 38.7 years; range, 22-53)
matched for age, weight, height and with similar cardiometabolic profile entered the study. An
exclusion criterion was the presence of known cardiovascular risk factors. Central
hemodynamic parameters and aortic pulse wave velocity (aPWV) were assessed non-
invasively by a SphygmoCor device. A significantly higher aPWV was recorded in PsA
patients when compared to controls. The difference remained statistically significant after
adjustment for age, weight, height, heart rate (HR) and central mean pressure (mean±SE; PsA,
8.3 ± 0.2 versus control, 6.8 ± 0.2 m/s; p < 0.0001). Among PsA patients, aPWV was related
to known duration of disease (r = 0.63; p = 0.003). This result was confirmed after adjustment
for the main confounders (β = 0.011; p = 0.013). These results support the concept of psoriatic
disease as a systemic condition involving not only the skin, joints and gastrointestinal tract but
also arterial vessels. The involvement of the vascular system indicates the presence of
pathogenetic mechanisms that could accelerate the atherosclerotic process in this condition.
Cardiovascular and metabolic risks in psoriasis and psoriatic

arthritis: pragmatic clinical management based on available
evidence.
Johnsson H; McInnes IB; Sattar N
Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research
Centre, University of Glasgow, UK. h.johnsson@doctors.org.uk
Several studies suggest that patients with psoriasis and, in particular, psoriatic arthritis (PsA)
are at increased risk of cardiovascular disease. These patients are also more likely to be obese
and to have diabetes and fatty liver disease. This article discusses the association between
psoriasis and PsA and cardiometabolic disorders, emphasising the need for better
consideration of simple lifestyle interventions. It also highlights areas for future research and
proposes a simple and pragmatic test portfolio to screen for cardiovascular risk and metabolic
disorders in patients at higher risk.
High prevalence of subclinical left ventricular dysfunction in

patients with psoriatic arthritis.
Shang Q; Tam LS; Yip GW; Sanderson JE; Zhang Q; Li EK; Yu CM
Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital,
Chinese University of Hong Kong, Hong Kong, China.
OBJECTIVE: Endothelial dysfunction and early atherosclerosis have been found in patients
with psoriatic arthritis (PsA) without cardiovascular disease (CVD) risk factors. Few studies
have investigated whether there is any early impairment of myocardial function. The aims of
our study were to determine the prevalence of subclinical left ventricular (LV) dysfunction in
PsA patients and the disease-related risk factors.
METHODS: Ninety-four PsA patients without clinical evidence of CVD and 63 healthy
subjects were enrolled. All underwent conventional echocardiography and tissue Doppler
imaging.
RESULTS: Sixty-one (65%) patients with PsA had evidence of subclinical LV dysfunction as
defined by mean myocardial peak systolic velocity (Sm) of basal 6 segments < 4.4 cm/s,
lateral E' < 11.5 cm/s, and/or lateral E/E' > 10. Thirty-six (38%) patients had only diastolic
dysfunction, 4 (4%) had only systolic dysfunction, and 21 (22%) had both systolic and
diastolic dysfunction. PsA patients with subclinical LV dysfunction were older, had a higher
age at diagnosis of PsA and of psoriasis, a longer disease duration, a higher prevalence of
hypertension and hyperlipidemia, higher levels of serum creatinine, and more
antihypertensive treatment than those with normal LV function. Multivariate regression
showed that age at diagnosis of PsA > 40 years (OR 3.388, 95% CI 1.065-10.777, p = 0.039)
and hypertension (OR 4.732, 95% CI 1.345-16.639, p = 0.015) were independent predictors
of subclinical LV dysfunction.
CONCLUSION: PsA patients without established CVD disease and in the absence of
traditional CV risk factors have a high prevalence of subclinical LV dysfunction.
Obesity and the risk of psoriatic arthritis: a population-based

study.
Love TJ; Zhu Y; Zhang Y; Wall-Burns L; Ogdie A; Gelfand JM; Choi HK
Department of Science, Education, and Innovation, Landspitali University Hospital,
Fossvogur, Reykjavik, Iceland.
BACKGROUND: Obesity is associated with an increased risk of psoriasis; however, its

potential impact on the risk of psoriatic arthritis (PsA) remains unclear.
OBJECTIVES: To evaluate the association between body mass index (BMI) and the risk of
PsA among patients with psoriasis from the general population.
METHODS: The authors conducted a cohort study using data from The Health Improvement
Network, an electronic medical records database representative of the UK general population,
collected between 1995 and 2010. The exposure of interest was the first BMI measured after
psoriasis diagnosis and endpoints were incident cases of physician-diagnosed PsA. The
authors estimated the RR of PsA after adjusting for age, sex, and histories of trauma, smoking
and alcohol consumption.
RESULTS: Among 75,395 individuals with psoriasis (43% male, mean follow-up of 5 years,
and mean age of 52 years), 976 developed PsA (incidence rate, 26.5 per 10,000 person-years).
The PsA incidence rates increased with increasing BMI. Compared with psoriasis patients
with BMI <25 kg/m(2), the RRs for developing PsA were 1.09 (0.93-1.28) for BMIs from
25.0 to 29.9, 1.22 (1.02-1.47) for BMIs from 30.0 to 34.9 and 1.48 (1.20-1.81) for BMIs
≥35.0. In our secondary analysis among all individuals, regardless of psoriasis (~2 million),
the corresponding multivariate RRs tended to be stronger (1.0, 1.17, 1.57, 1.96; p for trend
<0.001).
CONCLUSIONS: This general population study suggests that obesity is associated with an
increased risk of incident PsA and supports the importance of weight reduction among
psoriasis patients who often suffer from the metabolic syndrome and obesity.

psoriasis and psoriatic arthritis.
Tobin AM; Veale DJ; Fitzgerald O; Rogers S; Collins P; O'Shea D; Kirby B
Department of Dermatology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
tobin.annemarie@gmail.com
OBJECTIVE: Patients with psoriasis and psoriatic arthritis (PsA) have an increased incidence
of cardiovascular disease (CVD) and cardiovascular risk factors such as smoking,
hypertension, and metabolic syndrome compared to the normal population. Patients with
psoriasis and PsA may also have increased risk from nonconventional risk factors such as
raised levels of homocysteine and excessive alcohol consumption. We conducted a
comprehensive review of the literature on CVD and all cardiovascular risk factors in patients
with psoriasis and PsA.
METHODS: Data sources: All studies identified from a Medline (www.ncbi.nlm.nih.gov)

search pertaining to CVD, individual risk factors in psoriasis, and PsA were included. Study
selection: Studies included a healthy reference population, were published between 1975 and
2009, and were written in English.
RESULTS: Our search yielded 14 studies that documented rates of CVD in patients with
psoriasis and PsA compared to controls. Substantial evidence points to elevated risk of CVD
in patients with psoriasis and PsA.
CONCLUSION: It remains difficult to conclude if risk factors are caused by psoriasis or

share a common pathogenesis. Physicians treating patients with psoriasis and PsA must be
aware of all potential cardiovascular risk factors in their patients.
Asymptomatic hyperuricemia and serum uric acid

concentration correlate with subclinical atherosclerosis in
psoriatic arthritis patients without clinically evident
cardiovascular disease.
Semin Arthritis Rheum. 2009; 39(3):157-62 (ISSN: 1532-866X)
Gonzalez-Gay MA; Gonzalez-Juanatey C; Vazquez-Rodriguez TR; Gomez-Acebo I; Miranda-
Filloy JA; Paz-Carreira J; Martin J; Llorca J
Division of Rheumatology, Hospital Xeral-Calde, Lugo, Spain. miguelaggay@hotmail.com
OBJECTIVE: To establish whether serum uric acid concentration correlates with carotid
intima-media wall thickness (IMT) in a cohort of psoriatic arthritis (PsA) patients without
overt cardiovascular (CV) disease or classic CV risk factors who attended a community
hospital. METHODS: A series of 52 PsA patients were assessed by carotid ultrasonography.
Carotid IMT and carotid plaques were measured in the right common carotid artery. A
correlation between serum uric acid concentration and carotid IMT was assessed and receiver
operating characteristic curves to evaluate the ability of serum uric acid to predict carotid IMT
> 0.90 mm and carotid plaques were performed. RESULTS: PsA patients with hyperuricemia
(n = 6 [11.5%]) had greater carotid IMT (mean +/- standard deviation: 0.89 +/- 0.20 mm) than
those without hyperuricemia (n = 46 [89%]; 0.67 +/- 0.16 mm) (P = 0.01). Patients with
carotid IMT < 0.60 mm had lower mean serum uric acid levels (4.7 +/- 1.2 mg/dL) than those
with greater carotid IMT (5.3 +/- 1.7 mg/dL for patients with carotid IMT 0.76-0.90 mm and
6.4 +/- 1.3 mg/dL for those with carotid IMT > 0.90 mm; P for trend = 0.02). A significant
correlation between carotid IMT and serum uric acid concentration was observed (r = 0.337; P
= 0.01). High serum uric acid levels were associated with an increased risk of having carotid
IMT > 0.90 mm (Odds ratio = 2.66 [95% confidence interval: 1.08-6.53], P = 0.03, area under
receiver operating characteristic curve: 0.80) or with the presence of carotid plaques (Odds
ratio = 1.85 [95%; confidence interval: 1.01-3.38], P = 0.05, area under receiver operating
characteristic curve: 0.72). CONCLUSIONS: In PsA patients without clinically evident CV
disease there is a correlation between serum uric acid concentration and subclinical
atherosclerosis.
Prevalence of patient-reported comorbidities in early and

established psoriatic arthritis cohorts.
Khraishi M; MacDonald D; Rampakakis E; Vaillancourt J; Sampalis JS
Nexus Clinical Research, Memorial University of Newfoundland, 120 Stavanger Drive, St.
John's, NL A1A5E8, Canada. mkhraishi@nexusresearch.com
The aim of this study is to describe the comorbidity profile in patients with early and
established psoriatic arthritis (PsA). Patients with PsA were selected from a registry of
patients with psoriasis in Newfoundland. Patients with a diagnosis of psoriasis according to
the CASPAR classification criteria are entered in the registry at the time of diagnosis,
questioned on their medical history, and are followed indefinitely. Patients who were
diagnosed with PsA within the last 2 years were included in the early PsA cohort, whereas the
established cohort was comprised of patients with a diagnosis for ≥2 years. The general
population of Newfoundland without psoriasis or PsA was used as external standard to
conduct age- and gender-adjusted comparison of the comorbidity profile of the PsA cohorts to
the general population. A total of 108 (65.5%) and 57 (34.5%) patients were included in the
established and early PsA cohort, respectively. Patients with early and established PsA had
significantly higher age- and gender-adjusted prevalence of hypertension, diabetes,
depression, Crohn's disease, and chronic obstructive pulmonary disease. In addition, in the
early PsA cohort, the age-adjusted prevalence of coronary heart disease and angina was
significantly higher when compared to the general population. Distinct comorbidities are
associated with PsA even at early stages of disease progression, the early detection and
management of which could improve the patients' disability, morbidity, and quality of life.
Mortality in psoriatic arthritis - a single-center study from the

UK.
Buckley C; Cavill C; Taylor G; Kay H; Waldron N; Korendowych E; McHugh N
Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath, UK.
OBJECTIVE: To determine whether the mortality in a cohort of patients with psoriatic
arthritis (PsA) from a single center in the UK is significantly different from the general UK
population.
METHODS: Patients who were entered onto the PsA database at the Royal National Hospital
for Rheumatic Diseases, Bath, between 1985 and 2007 were included in this study.
Information on patient deaths was collected retrospectively. The National Health Service
(NHS) Strategic Tracing Service was used to establish which patients were alive and which
had died. Date and cause of death were confirmed by death certificates from the Registry of
Births, Marriages and Deaths. A standardized mortality ratio (SMR) was calculated by
matching the patient data to single-year, 5-year age-banded England and Wales data from the
Office of National Statistics.
RESULTS: In this cohort of 453 patients with PsA (232 men, 221 women), there were 37
deaths. Sixteen men and 21 women died. The SMR for the men was 67.87% (95% CI 38.79,
110.22), and for the women, 97.01% (95% CI 60.05, 148.92) and the overall SMR for the PsA
cohort was 81.82% (95% CI 57.61, 112.78). The leading causes of death in this cohort were
cardiovascular disease (38%), diseases of the respiratory system (27%), and malignancy
(14%).
CONCLUSION: These results suggest that mortality in our single-center PsA cohort is not
significantly different from the general UK population. No increased risk of death was
observed in this cohort.
Cardiovascular morbidity in psoriatic arthritis.

Gladman DD; Ang M; Su L; Tom BD; Schentag CT; Farewell VT
Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Hospital, Toronto,
Ontario, Canada. dafna.gladman@utoronto.ca
BACKGROUND: Increasing evidence for cardiovascular mortality among patients with

psoriasis and psoriatic arthritis (PsA) has accumulated, together with evidence for increased
prevalence of risk factors for cardiovascular disease (CVD). OBJECTIVES: To describe
cardiovascular morbidity in PsA, determine its prevalence and identify risk factors for its
development. METHODS: At the University of Toronto, patients were followed up
prospectively according to a standard protocol, including disease-related features and
comorbidities. Patients with CVD, including myocardial infarction (MI), angina, hypertension
and cerebrovascular accident (CVA), were identified. The prevalence of CVD morbidities in
these patients was compared with data from the Canadian Community Health Survey through
standardised prevalence ratios (SPRs). Cox relative risk regression analysis was used to
analyse risk factors. RESULTS: At the time of analysis, 648 patients were registered in the
database. After clinic entry, 122 developed hypertension, 38 had an MI and 5, 21 and 11 had
CVA, angina and congestive heart failure (CHF), respectively. 155 patients had at least one of
these conditions. The SPRs for MI (2.57; 95% CI 1.73 to 3.80), angina (1.97; 95% CI 1.24 to
3.12) and hypertension (1.90; 95% CI 1.59 to 2.27) were statistically significant, whereas the
SPRs for CHF (1.19; 95% CI 0.50 to 2.86) and CVA (0.91; 95% CI 0.34 to 2.43) were not.
Factors associated with CVD included diabetes, hyperlipidaemia and high Psoriasis Area and
Severity Index scores. CONCLUSION: Patients with PsA are at increased risk of
cardiovascular morbidities compared with the general population. In addition to known risk
factors for CVD, severe psoriasis is an important predictor in patients with PsA.
Th17 and interleukin 23 in the pathogenesis of psoriatic
arthritis and spondyloarthritis.
J Rheumatol Suppl. 2012; 89:15-8 (ISSN: 0380-0903)
Cauli A; Mathieu A
Rheumatology Unit, Department of Medical Sciences, Policlinico of the University of
Cagliari, Monserrato, Cagliari, Italy. cauli@medicina.unica.it
Psoriatic arthritis and spondyloarthritis (SpA) are complex immune-mediated diseases

affecting peripheral and axial joints. T cells have been considered fundamental in triggering
the disease and maintaining the process in the chronic phase. The recent discovery of the
CD4+ Th17 lymphocyte subset and the interleukin 23/interleukin 17 axis has further
contributed to the definition of unknown pathways, challenging previous models and the role
of Th1/Th2 T cells in immune mediated diseases, including SpA.
Increased prevalence of the metabolic syndrome in patients

with psoriatic arthritis.
Metab Syndr Relat Disord. 2010; 8(4):331-4 (ISSN: 1557-8518)
Raychaudhuri SK; Chatterjee S; Nguyen C; Kaur M; Jialal I; Raychaudhuri SP
VA Medical Center, Mather, California, USA.
OBJECTIVES: Psoriasis (PsO) is a common chronic T cell-mediated inflammatory disorder

traditionally thought to manifest in the skin and joints (psoriatic arthritis, PsA). Recently, it
has been shown that these patients have an increased risk for myocardial infarction and this
was greater with increasing severity of psoriasis. Patients with psoriasis have reported to have
cardiometabolic disturbances including obesity, insulin resistance, and dyslipidemia. This
constellation of risk factors, referred to as the metabolic syndrome, increases the risk for
atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus. The aim of this
study was to determine the prevalence of metabolic syndrome in PsA.
METHODS: In our study, we examined the records of 105 patients with PsA to determine the
prevalence of metabolic syndrome in PsA. This was a retrospective analysis of the
Sacramento Veterans Affairs database.
RESULTS: Our results demonstrated an increased prevalence of the metabolic syndrome in

patients with PsA (61/105 patients or 58.1%) compared to the 35.2 % reported for the Third
National Health and Nutrition Examination Survery (NHANES III) data.
CONCLUSIONS: Thus, patients with PsA have a very high prevalence of metabolic
syndrome, which predisposes them to an increased risk of both diabetes and ASCVD.
The metabolic syndrome predicts cardiovascular events: results of a 13-year

follow-up in initially healthy 58-year-old men.
Schmidt C; Bergström GM
1 The Wallenberg Laboratory for Cardiovascular Research, Institution for Medicine, Department of Molecular and Clinical
Medicine, the Sahlgrenska Academy at Gothenburg University , Göteborg, Sweden .
Abstract Background: The metabolic syndrome is a global health problem and is associated with subsequent development of
cardiovascular disease (CVD). However, data are scarce concerning prospective association of the syndrome and CVD in
populations free of diabetes and previous CVD that also is free of all cardiovascular drugs. The aim of this study was to
assess the risk of cardiovascular events due to the metabolic syndrome in a population-based cohort of initially healthy, low-
risk, and medication-free 58-year-old Swedish men during 13-years of follow-up. Methods: From a total population sample
of 1728 subjects, a stratified and randomly selected group of 391 subjects was included. The metabolic syndrome was
defined according to the National Cholesterol Education Program. Cardiovascular events and cause of death were
investigated by contact with the Centre of Epidemiology at the National Board of Health and Welfare. Results: The metabolic
syndrome increased the risk of cardiovascular events with a hazard ratio of 2.1 [95% confidence interval (CI) 1.3-3.4],
P=0.003. When adjusted for the factors of leisure-time physical activity, smoking habits, alcohol intake, and low-density
lipoprotein cholesterol (LDL-C), the hazard ratio was 2.0 (95% CI 1.1-3.4), P=0.016. Conclusion: In a 13-year follow-up in
initially healthy men, the metabolic syndrome increases the risk of cardiovascular events by two-fold. This risk was
maintained also after adjustment for lifestyle factors.
Waist circumference and metabolic syndrome: the risk for silent coronary artery
disease in males.
Vakil KP; Malhotra S; Sawada S; Campbell SR; Sayfo S; Kamalesh M

Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
BACKGROUND: Waist circumference (WC) is a component used to define metabolic syndrome. However, its role as an
independent predictor of silent coronary artery disease (CAD), above its contribution to metabolic syndrome, remains
unknown.
METHODS: Male veterans without known CAD, undergoing cardiac stress testing for indications other than typical angina
or its equivalent, were evaluated for the presence of silent CAD. High WC and metabolic syndrome were defined per the
revised National Cholesterol Education Program (NCEP-R) and the International Diabetes Federation (IDF) criteria.
RESULTS: Data on 1,071 patients (age 61±11 years) were analyzed retrospectively. On multivariable logistic regression
analysis [odds ratio (OR), 95% confidence interval (CI), P value), a WC ≥94 cm (1.42, 1.04-1.93; P=0.026), metabolic
syndrome by NCEP-R (1.73, 1.29-2.33; P<0.0001), and metabolic syndrome by IDF (1.57, 1.17-2.11; P=0.003) were
independent predictors of silent CAD. When comparing patients meeting criteria for metabolic syndrome defined by either
NCEP-R or IDF, the prevalence of silent CAD was not statistically different (P=0.86). The prevalence of silent CAD
associated with a high WC was not inferior to that seen between silent CAD and metabolic syndrome as defined by either
criterion. Last, among patients with metabolic syndrome defined by NCEP-R, those with a high WC as a defining component
of metabolic syndrome had a higher prevalence of silent CAD (30% vs. 20%; P=0.026).
CONCLUSION: A WC ≥94 cm in males is independently associated with an increased prevalence of silent CAD. In patients
with metabolic syndrome, this prevalence is increased by the presence of high WC.
Electrocardiographic abnormalities associated with the metabolic syndrome and

its components: the multi-ethnic study of atherosclerosis.
Ebong IA; Bertoni AG; Soliman EZ; Guo M; Sibley CT; Chen YD; Rotter JI; Chen YC; Goff DC
Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina 27157, USA.
iebong@wfubmc.edu
BACKGROUND: The association between metabolic syndrome and electrocardiographic (ECG) abnormalities is not well
established.
METHODS: ECG tracings of 6,765 men and women aged 45-84 years, free of clinical cardiovascular disease, from the
Multi-Ethnic Study of Atherosclerosis were obtained (2000-2002) and classified as normal or having major or minor
abnormalities. We evaluated the associations of metabolic syndrome and its components with ECG abnormalities, adjusting
for age, ethnicity, and gender and testing for effect modification by ethnicity and gender.
RESULTS: The associations of metabolic syndrome, hypertension, and high triglycerides with ECG abnormalities varied
significantly by gender. In males, metabolic syndrome and hypertension were significantly associated with major ECG
abnormality [1.69 (1.33-2.13), and 2.22 (1.72-2.86), respectively] after adjusting for ethnicity and gender. Hypertension was
also associated significantly with minor ECG abnormality in males after adjusting for age and ethnicity. In females, metabolic
syndrome and hypertension were significantly associated with major [1.84 (1.44-2.37), and 1.68 (1.27-2.22), respectively]
and minor [1.38 (1.19-1.59), and 1.53 (1.32-1.79), respectively] ECG abnormalities after adjusting for age and ethnicity. High
triglycerides were only significantly associated with major ECG abnormality in females after adjusting for age and ethnicity.
After adjusting for age, ethnicity, and gender, central obesity and high fasting blood glucose were significantly associated
with major and minor ECG abnormalities, whereas low high-density lipoprotein cholesterol was significantly associated with
major ECG abnormality only.
CONCLUSIONS: Metabolic syndrome and its components are associated with major and/or minor ECG abnormalities. The
relationship of metabolic syndrome, hypertension, and high triglycerides with ECG abnormalities varied according to gender.
Optimal uric acid threshold to identify insulin resistance in healthy women.

Salazar MR; Espeche WG; March CE; Marillet AG; Balbín E; Dulbecco CA; Carbajal HA
Hospital Universitario Gral. San Martín, La Plata, Buenos Aires, Argentina. salazarlandea@gmail.com
BACKGROUND: Identifying insulin-resistant (IR) individuals is an issue of particular interest in the assessment of
cardiometabolic risk, but there is no simple way to accomplish this task. Our aims were to determine the relationship between
uric acid and insulin resistance and to define the optimal uric acid cutoff to identify insulin resistance in women.
METHODS: A population-based sample of 588 women without cardiovascular diseases, diabetes, or low glomerular filtration
rate (GFR) was divided according to uric acid tertiles. Systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting
glucose, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C),
TG/HDL-C ratio, insulin [fasting plasma insulin (FPI)], and homeostasis model assessment of insulin resistance (HOMA-IR)
were compared between the mentioned tertiles. Receiver operating characteristic (ROC) curves were constructed to
determinate the optimal cutoff of uric acid and identify IR individuals defined by the top tertile of FPI and HOMA-IR. The
same variables were compared using the top tertile of uric acid and the maximum Youden index as cutoffs. The P values were
adjusted by age, GFR, and body mass index (BMI) using analysis of covariance (ANCOVA).
RESULTS: FPI, HOMA-IR, and all of the cardiometabolic risk factors increased through uric acid tertiles. Both cutoffs of
uric acid, estimated by the top tertile and by ROC, were identical (4.0 mg/dL). FPI, HOMA-IR, SBP, DBP, TG, TG/HDL-C
ratio, and fasting glucose were higher, whereas HDL-C was lower in women who had uric acid levels >4.0 mg/dL. All of the
differences remained significant after the adjustment by age and GFR.
CONCLUSION: In healthy women, uric acid levels >4.0 mg/dL were associated with all the markers of IR.
Serum adipokine levels in type 1 diabetic patients: association with carotid intima
media thickness.
Yazıcı D; Yavuz D; Öğünç AV; Sirikçi Ö; Toprak A; Deyneli O; Akalın S

Section of Endocrinology and Metabolism, Marmara University Medical School, Istanbul, Turkey. dilekdy2002@yahoo.com
BACKGROUND: Adipokines are markers of insulin resistance and play a role in the atherosclerotic process. The association
of adipokines with the macrovascular complications of type 1 diabetes mellitus (DM) needs to be determined. The aim of this
study was to measure serum adiponectin, leptin, and resistin levels in type 1 DM patients and investigate their relationship
with carotid intima media thickness (CIMT), a clinical marker of atherosclerosis.
METHODS: Seventy-five type 1 DM patients and 115 sex and age-matched healthy controls were included in the study.
Serum adiponectin, leptin, and resistin levels were measured by the enzyme-linked immunosorbent assay (ELISA method).
CIMT was assessed by Doppler ultrasonography.
RESULTS: Adiponectin levels in diabetics were higher (25.8±14.8 μg/mL vs. 5.5±7.3 μg/mL; P<0.0001) and leptin levels
were lower than controls (9.4±6.2 ng/mL vs. 12.8±8.6 ng/mL; P=0.01). Resistin levels were also higher in the diabetic group
compared to controls (2.1±1.4 ng/mL vs. 1.6±0.8 ng/mL; P=0.04). Adiponectin was correlated negatively with CIMT (r=-
0.24, P=0.03), age (r=-0.30, P=0.02), BMI (r=-0.33, P=0.02), waist-to-hip ratio (WHR) (r=-0.38, P=0.01) and positively with
creatinine (r=0.44, P=0.004). Leptin levels were correlated with total cholesterol (r=0.53, P=0.01) and high-density
lipoprotein (HDL) (r=0.67, P=0.001). Resistin was correlated with CIMT (r=0.24, P=0.03) and systolic blood pressure
(r=0.48, P=0.009). Multivariate analysis revealed resistin and creatinine to be independent predictors of CIMT among
adiponectin, leptin, resistin, WHR, glycosylated hemoglobin (HbA1c), and creatinine.
CONCLUSIONS: Increased adiponectin correlates negatively and resistin positively with CIMT in type 1 diabetic patients,
but adjusting for other known predictors reveals only resistin to be associated with subclinical atherosclerosis in this group of
patients.
Increased waist circumference is the component of metabolic syndrome the most

strongly associated with elevated C-reactive protein in elderly.
Assoumou HG; Barthelemy JC; Garet M; Dauphinot V; Celle S; Pichot V; Kossovsky M; Gaspoz JM; Roche F
Clinical and Exercise Physiology Laboratory, University Hospital and Jean Monnet University, PRES University of Lyon,
Saint-Etienne, France.
BACKGROUND: Metabolic syndrome is associated with higher C-reactive protein (CRP) serum levels, a common
biological marker of inflammation. However, the respective contribution of each component of metabolic syndrome to the
inflammation has not been established. The aim of the present study was to assess the strength of the association between
metabolic syndrome components and CRP in elderly subjects.
METHODS: This was an observational, cross-sectional study on 921 volunteers (65.6 ± 0.8 years old) from the PROOF
(PROgnostic indicator OF cardiovascular and cerebrovascular events) Study. Anthropometric, biological, and clinical
parameters were evaluated. Subjects with a CRP value less than 10 mg/L were considered. The relationships between the
metabolic syndrome components and CRP tertiles were evaluated using logistic regression analysis.
RESULTS: After adjustment for gender and for body mass index, metabolic syndrome and high-CRP tertile were
significantly associated [odds ratio (OR)=2.37, 95% confidence interval (CI) 1.46-3.87, P<0.001]. Waist circumference
demonstrated the strongest association with the high-CRP tertile (OR=1.75, 95% CI 1.05-2.91, P<0.05). In addition, CRP
levels significantly increased with the number of metabolic syndrome components.
CONCLUSIONS: Among metabolic syndrome components, waist circumference showed the strongest association with the
high-CRP tertile in elderly subjects. These findings help to explain the strong association between waist circumference and
cardiovascular morbidity.
Increased prevalence of the metabolic syndrome in patients

Raychaudhuri SK; Chatterjee S; Nguyen C; Kaur M; Jialal I; Raychaudhuri SP
VA Medical Center, Mather, California, USA.
OBJECTIVES: Psoriasis (PsO) is a common chronic T cell-mediated inflammatory disorder

traditionally thought to manifest in the skin and joints (psoriatic arthritis, PsA). Recently, it
has been shown that these patients have an increased risk for myocardial infarction and this
was greater with increasing severity of psoriasis. Patients with psoriasis have reported to have
cardiometabolic disturbances including obesity, insulin resistance, and dyslipidemia. This
constellation of risk factors, referred to as the metabolic syndrome, increases the risk for
atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus. The aim of this
study was to determine the prevalence of metabolic syndrome in PsA.
METHODS: In our study, we examined the records of 105 patients with PsA to determine the
prevalence of metabolic syndrome in PsA. This was a retrospective analysis of the
Sacramento Veterans Affairs database.
RESULTS: Our results demonstrated an increased prevalence of the metabolic syndrome in

patients with PsA (61/105 patients or 58.1%) compared to the 35.2 % reported for the Third
National Health and Nutrition Examination Survery (NHANES III) data.
CONCLUSIONS: Thus, patients with PsA have a very high prevalence of metabolic
syndrome, which predisposes them to an increased risk of both diabetes and ASCVD.
A study of intima media thickness and their cardiovascular

risk factors in patients with psoriatic arthritis.
Acta Medica (Hradec Kralove). 2009; 52(3):107-16 (ISSN: 1211-4286)
Mazlan SA; bin Mohamed Said MS; Hussein H; binti Shamsuddin K; Shah SA; Basri H
Hospital Ampang, Medical Department, Kuala Lumpur, Malaysia.
INTRODUCTION: Psoriatic Arthritis (PsA) is an inflammatory arthritis associated with

Psoriasis. Its recognition as an inflammatory disease distinct from Rheumatoid Arthritis has
put forward for consideration several questions regarding its specific CVS mortality and
morbidity (9, 11, 16, 26). Carotid intima media thickness is a useful surrogate and sensitive
marker to determine atherosclerosis even in its subclinical stages (6, 14, 22, 27, 32).
OBJECTIVE: Prevalence of carotid intima media thickness in patients with Psoriatic arthritis
is unknown in Asian population. We aim to identify the presence of subclinical atherosclerosis
in patients with psoriatic arthritis and disease activity association and its predictors in a series
of patients with PsA attended to the rheumatology clinic, tertiary hospitals. METHODS: A
total of 63 patients with PsA who fulfilled the CASPAR criteria were recruited from UKM
Medical Centre and Hospital Putrajaya. Common carotid intima media thickness (IMT) was
measured in both right and left carotid artery by using high resolution B-mode ultrasound.
This was a cross sectional study first done in Malaysia for PsA patients. RESULTS: The
positive IMT (IMT > 1.00 mm) among PsA was observed in 10 out of 63 patients (15.9 %)
regardless of background cardiovascular risk. The mean +/- SD of IMT was 0.725 +/-0.260
mm for this study. Variables significantly associated with positive IMT (p < 0.05) included
age at the time of study (p = 0.005), waist circumference (p = 0.001), Hypertension (p =
0.007), Diabetes (p = 0.002) and Metabolic syndrome (p = 0.001) and not associated with
gender, ethnicity, duration of PsA disease, pattern of PsA, disease activity and severity. Above
all, only age had positive IMT independent predictor (p = 0.032), with OR 1.116; 95 % CI
(1.010-1.234). CONCLUSIONS: There was a significant association between CVS risk and
positive Intima Media Thickness in Psoriatic Arthritis patients. Otherwise, there was no
association in disease activity, disease severity and DMARDS therapy with positive Intima
Media Thickness in Psoriatic Arthritis patients. The study was approved by Research and
Ethics Committee of the faculty of medicine, Universiti Kebangsaan Malaysia with project
code FF-114-2008 and by Community Research Center (CRC) of National Institutes of Health
(NIH) for the case study in Hospital Putrajaya with the project code NMRR-08-970-2125.
Cardiovascular risk profile of patients with

spondylarthropathies, particularly ankylosing spondylitis
and psoriatic arthritis.
Semin Arthritis Rheum. 2004; 34(3):585-92 (ISSN: 0049-0172)
Peters MJ; van der Horst-Bruinsma IE; Dijkmans BA; Nurmohamed MT
Department of Rheumatology, VU University Medical Centre, Jan van Breemen Institute,
Slotervaart Hospital, Amsterdam, The Netherlands.
OBJECTIVE: To evaluate the cardiovascular risk profile of spondylarthropathy patients,

particularly ankylosing spondylitis and psoriatic arthritis. METHODS: A Pubmed literature
search was performed to collect English-language articles for this clinically orientated review.
Studies were selected if they included (cardiovascular) mortality and morbidity and/or data
about cardiovascular risk factors in spondylarthropathies. RESULTS: Ankylosing spondylitis
as well as psoriatic arthritis appear to be associated with an increased cardiovascular mortality
and morbidity. Several factors, ie, smoking, altered lipid profile, hypertension, increased
fibrinogen level, enhanced number of platelets, and hypercoagulability might explain the
enhanced cardiovascular risk. Moreover, a decline in physical activity, the presence of HLA-
B27, and inflammation may play a role. Finally, undertreatment of cardiovascular morbidity
also may contribute to the higher cardiovascular risk. CONCLUSIONS: The available data
indicate an increased cardiovascular risk in spondylarthropathy patients, particularly those
with ankylosing spondylitis and psoriatic arthritis. RELEVANCE: Rheumatologists should be
aware of the enhanced cardiovascular risk in patients with ankylosing spondylitis and
psoriatic arthritis. If modifiable cardiovascular risk factors are identified, treatment could
ultimately result in a lower cardiovascular morbidity and mortality.
Measurement of disease activity in psoriatic arthritis.

Extended report.
Z Rheumatol. 2003; 62(1):60-5 (ISSN: 0340-1855)
Ujfalussy I; Koó E
Polyclinic of the Hospitaller Brothers of St. John of God, 2nd Department of Rheumatology,
1023 Budapest, Arpád f. u 7, Hungary.
OBJECTIVE: To determine whether activity indices, generally accepted in rheumatoid

arthritis (RA) are useful and valid to measure disease activity in psoriatic arthritis (PsA)
patients with peripheral arthritis. METHODS: 38 PsA patients were studied before and after a
one year DMARD treatment. Extended and reduced tender and swollen joint counts, Ritchie
articular index, Health Assessment Questionnaire HAQ) score, erythrocyte sedimentation rate
(ESR) morning stiffness, the patient's and the assessor's global assessment (PGA and AGA)
were recorded. Disease activity scores, EULAR, ACR and Clegg improvement criteria were
calculated. RESULTS: All indices correlated well before and after treatment with AGA (r >
0.337, p < 0.042), except morning stiffness and tender joint counts. After treatment, PGA
correlated well only with the 68 and 28 tender joint counts, ESR and HAQ (r > 0.340, p <
0.05). The response to DMARD treatment was well characterized with the changes in the
number of tender and swollen joint counts, and DAS4, DAS3, DAS28. The changes
correlated with the PGA and AGA. The level of agreement between Clegg and the EULAR
improvement criteria with both extended and reduced joint count was comparable (p < 0.01).
CONCLUSION: The well-known activity indices generally accepted in RA, as tender and
swollen joint count, DAS3, DAS4, DAS28, are useful and valid indices measuring arthritis
activity in PsA with peripheral arthritis. The correlation between Clegg and EULAR
improvement classification indices were similar. Both seemed to characterize changes
authenticated during DMARD treatment.
!!!Effects of tumor necrosis factor-alpha blockade on

metabolic syndrome components in psoriasis and psoriatic
arthritis and additional lessons learned from rheumatoid
arthritis.
Dermatol Ther. 2009; 22(1):61-73 (ISSN: 1529-8019)
Channual J; Wu JJ; Dann FJ
School of Medicine, University of California-Irvine, Irvine, CA, USA.
Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic T cell-mediated inflammatory
diseases that manifest not only in the skin and joints but also in the form of cardiometabolic
disturbances, which include insulin resistance, dyslipidemia, and obesity. Thus, PsO and PsA
patients are predisposed to metabolic syndrome (MetS), diabetes, and cardiovascular disease.
In recent years, the introduction of targeted therapy in the form of tumor necrosis factor-alpha
(TNF-alpha) antagonists, such as infliximab, etanercept, and adalimumab has been an
important and effective addition to the treatment armamentarium for PsO and PsA. Although
TNF-alpha antagonists have produced promising results clinically in reducing cutaneous and
joint manifestations of PsO and PsA, their effects on MetS components in these patients are
presently unclear. This review summarizes the current limited evidence on the effects of TNF-
alpha antagonists on MetS components in PsO and PsA patients and extrapolates from related
literature in rheumatoid arthritis, which is also a T cell-mediated inflammatory disease, for
additional information.
Psoriatic arthritis as a distinct disease entity.

J Postgrad Med. 2007; 53(1):63-71 (ISSN: 0022-3859)
Leung YY; Tam LS; Kun EW; Li EK
Department of Medicine and Geriatrics. Taipo Hospital, Hong Kong SAR.
katyccc@hotmail.com
Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease characterized by joint

inflammation associated with cutaneous psoriasis. For many years, the amount of attention
directed to PsA had been less than that for various other arthropathies. With the advances in
understanding its pathogensis, it is now recognized as a distinct disease entity with
characteristic features. Psoriatic arthritis has a greater tendency towards asymmetric
oligoarticular involvement, distal interphalangeal involvement and spondylitis. Associated
features such as enthesitis and dactylitis are more common. Specific radiological features
include ankylosis and bone resorption. With the availability of potent new therapeutic agents
for psoriasis and PsA, interest in research and clinical care for these conditions has been
reinvigorated. Anti-TNF therapy has achieved encouraging efficacy in both the joints and skin
disease, improving function and quality of life and inhibiting radiological progression
measured in patients with PsA and psoriasis. Biologic agents may have the potential in
addressing the unmet medical need in patients with PsA.
Protein oxidation markers in the serum and synovial fluid of

psoriatic arthritis patients.
J Clin Lab Anal. 2008; 22(3):210-5 (ISSN: 0887-8013)
Firuzi O; Spadaro A; Spadaro C; Riccieri V; Petrucci R; Marrosu G; Saso L
Dipartimento di Fisiologia Umana e Farmacologia Vittorio Erspamer, Sapienza Università di
Roma, Piazzale Aldo Moro 5, Rome, Italy.
The role of oxidative stress has been studied in rheumatoid arthritis (RA) and other
inflammatory joint diseases to some extent, but its importance in psoriatic arthritis (PsA) has
rarely been investigated. The aim of this study was to analyze the levels of protein oxidation
markers, sulfhydryl (SH) and carbonyl (CO) groups, in the synovial fluid (SF) and serum of
PsA patients and compare them with the findings in RA and osteoarthritis (OA) patients. A
total of 49 subjects with a knee-joint effusion including 16 PsA, 18 RA, and 15 OA patients
were studied. In all patients, the levels of SH groups measured in the serum and SF inversely
correlated with the number of white blood cells (WBC) (P<0.05) and the percentage of
polymorphonuclear leukocytes (PMN) (P<0.01) in SF. Serum SH levels inversely correlated
with serum erythrocyte sedimentation rate (ESR) (P<0.02) and C-reactive protein (CRP)
(P<0.05) values. The SH levels in SF were significantly lower in patients affected by PsA and
RA compared to OA cases (P<0.02). The serum SH levels in PsA were lower than OA
(P<0.001) and higher than RA patients (P<0.05). The serum and synovial levels of CO groups
in PsA, RA, and OA patients were similar. Our study provides novel evidence on the
involvement of protein oxidation in PsA and confirms the important role of oxidative stress in
the pathogenesis of RA. These data suggest that antioxidant agents can potentially be a useful
addition to the conventional therapy in the management of these diseases.
Evaluation of oxidative stress in rheumatoid and psoriatic

arthritis and psoriasis.
Clin Ter. 2009; 160(6):467-72 (ISSN: 1972-6007)
Coaccioli S; Panaccione A; Biondi R; Sabatini C; Landucci P; Del Giorno R; Fantera M;
Monno Mondo A; Di Cato L; Paladini A; Fatati G; Puxeddu A
Department of Internal Medicine and Rheumatology Unit. University of Perugia School of
Medicine, Didactic and Scientific District of Terni, Santa Maria General Hospital, Terni, Italy.
scoaccioli@tin.it
INTRODUCTION: The aim of the present study is to discuss the importance of the processes
of oxidative stress in the pathogenesis of certain autoimmune diseases, to search for an
appropriate assessment marker, and to debate current approaches which have been proposed
for the treatment of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA), and Psoriasis (Ps).
MATERIALS AND METHODS: The total antioxidant capacity (TAC), the thiolic capacity
(TC), and the serum hydroperoxide concentration (SHC) were measured in 37 subjects: 13
with RA, 8 with PsA, 8 with Ps, and 8 healthy controls.
RESULTS: SHC levels were significantly higher in patients with RA (p = 0.01), as well as in
those with PsA (p = 0.005) and Ps (p = 0.002) in comparison with the control group.
However, a significant reduction in the TAC values in the serum of all three groups (RA, p =
0.03; PsA, p = 0.005; Ps, p = 0.001) were observed in comparison with the healthy controls.
The thiolic concentration were found to have significantly diminished in patients with RA (p
=0.0005) and Ps (p = 0.0005) in comparison with the control group. Our findings have
brought out the fact that the therapeutic treatment of RA using biological drugs is more than
satisfactory in accord with the considerable increase in the TAC values, although not
significantly, compared to those patients treated with DMARDs.
CONCLUSIONS: The determination of the parameters of oxidative stress utilising these

methods may be useful as a quick test, and as routine in monitoring the state of oxidative
stress in patients suffering from RA, PsA, and Ps, so that a more effective treatment for ROS
can be undertaken accordingly. The administration of biological drugs seems to have a role in
increasing the mechanism of the barrier which the body possesses against oxidative stress.

rheumatoid arthritis, psoriatic arthritis, and ankylosing
spondylitis.
Han C; Robinson DW; Hackett MV; Paramore LC; Fraeman KH; Bala MV
Centocor Inc., Malvern, PA 19335, USA. chan3@cntus.jnj.com
OBJECTIVE: To compare the prevalence of cardiovascular diseases and their risk factors
between patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing
spondylitis (AS) and control subjects. METHODS: Data for patients continuously enrolled in
an integrated outcomes database between January 1, 2001, and December 31, 2002, with
International Classification of Diseases, 9th Revision codes of 714.x (RA), 696.0 (PsA), or
720.0 (AS) were evaluated in this cross-sectional comparative study. Control groups were
established for each patient group (1:4 ratio) by matching on the basis of age, sex, geographic
region, and length of time in plan. Age- and sex-adjusted prevalence of cardiovascular
comorbidities and risk factors were calculated; the prevalence ratio of the comorbidities and
risk factors for the patient groups compared with the control population were estimated. Use
of selected cardiovascular medications was also compared between patient and control
groups. RESULTS: The RA, PsA, and AS cohorts comprised 28,208, 3066, and 1843 patients,
respectively. The prevalence ratio of ischemic heart disease (1.5, 1.3, 1.2), atherosclerosis
(1.9, 1.4, 1.5), peripheral vascular disease (2.4, 1.6, 1.6), congestive heart failure (2.0, 1.5,
1.8), cerebrovascular disease (1.6, 1.3, 1.7), type II diabetes (1.4, 1.5, 1.2), hyperlipidemia
(1.2, 1.2, 1.2), and hypertension (1.3, 1.3, 1.3) were higher in patients than controls. For RA,
PsA, and AS, use of angiotensin-converting enzyme inhibitors, calcium channel blockers,
diuretics, nitrates/vasodilators, anticoagulants, and antihyperlipidemia agents was
significantly higher in patients than controls. CONCLUSION: Cardiovascular diseases and
their risk factors were more common in patients with RA, PsA, and AS than in matched
controls.
Laboratory findings in psoriatic arthritis.

Reumatismo. 2007; 59 Suppl 1:52-5 (ISSN: 0048-7449)
Punzi L; Podswiadek M; Oliviero F; Lonigro A; Modesti V; Ramonda R; Todesco S
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of
Padova, Italy. punzireu@unipd.it
Psoriatic arthritis (PsA) has been classically defined as an inflammatory arthritis associated
with psoriasis. However, in comparison with other relevant inflammatory arthropathies, in
which a definite diagnosis is frequently possible only by means of laboratory investigations,
in PsA true laboratory diagnostic markers are lacking. Some markers are utilised more to
differentiate other diseases than to characterise PsA. For example in polyarticular PsA, which
may be in some cases indistinguishable from RA, the rheumatoid factor (RF) or the more
specific and recently introduced antibodies to cyclic citrullinated peptides (anti-CCP), may be
useful to better identify RA. However, RF was found in 5% to 13% of patients with PsA, and
anti-CCP may be observed in almost similar percentage. The determination of ESR and/or
CRP is frequently disappointing in PsA, since they are both elevated in only half of the
patients with PsA. However, ESR and/or CRP are included in the most utilised response
criteria for RA, such as ACR and DAS, and, in addition are also considered reliable in the
assessment of PsA. Furthermore, elevated levels of ESR have been proposed as one of the
best predictors of damage progression and, in addition, a low ESR seems protective, while an
ESR >15 mm/h is one of the factors associated with an increased mortality in PsA. The
synovial fluid (SF) effusion is much higher in PsA, in comparison with other arthropathies.
When available, SF analysis may offer additive information useful for the diagnosis, such as
the increased number of leukocytes, which underlines the inflammatory nature of the effusion
even in a patient with normal serum levels of acute phase response. We found that elevated
IL-1 levels in SF of patients with early disease (<6 months), may be predictive of an evolution
in polyarticular form at follow-up. This observation is in keeping with the crucial role that
inflammatory cytokines play in PsA, probably related to a genetic predisposition. The recent
introduction in PsA of anti-TNF-alpha agents and the demonstration of their efficacy in the
management of many clinical disease expressions including peripheral arthropathy, axial
involvement, enthesopathy and skin manifestations, have stimulated the research also in the
field of the possible laboratory markers.
Metabolic disorders in patients with psoriasis and psoriatic

arthritis.
Curr Rheumatol Rep. 2006; 8(5):355-63 (ISSN: 1523-3774)
Mallbris L; Ritchlin CT; Ståhle M
Department of Medicine, Dermatology Unit, Karolinska Institutet, 171 76 Stockholm,
Sweden. lotus.mallbris@ki.se
Psoriasis is one of the common complex disorders in Western world, affecting 2% to 3% of

the population. Recent studies indicate that psoriasis is associated with an increased risk of
comorbidity and mortality compared to the general population. It appears that patients with
psoriasis have a higher prevalence of metabolic disorders such as diabetes, hypertension,
obesity, and hyperlipidemia, as well as a higher frequency of cigarette smoking. These
concomitant diseases can complicate the treatment of psoriasis. Even though the etiology of
these associations is elusive, physicians should be aware of them and take active steps to
reduce the risk profiles of patients with psoriasis and psoriatic arthritis, in order to lessen
mortality and comorbidity.
Electrocardiographic findings in psoriatic arthritis: a case-
controlled study.
Feld J; Weiss G; Rosner I; Rozenbaum M; Laor A; Rimar D; Eder L; Bitterman H; Zisman D
Department of Rheumatology, Bnai Zion Medical Center, Lin Clinic, Clalit Health Services,
Haifa, Israel.
OBJECTIVE: We assessed cardiac conduction properties in patients with psoriatic arthritis

(PsA). METHODS: Electrocardiogram (ECG) scans of 92 patients with PsA were compared
to 92 age and sex matched nonpsoriatic, nonarthritic patients from general practice serving as
controls. RESULTS: PR interval was found to be significantly longer in the PsA group
compared to controls, 159.6 +/- 21 ms versus 151.3 +/- 26 ms, respectively (p = 0.021). No
statistical difference was found with respect to the QRS interval or other atrial or ventricular
conduction disturbances studied. No correlation was found between the PR interval and
disease duration or PsA subtype. The use of nonsteroidal antiinflammatory drugs did not
affect the PR interval. Methotrexate was not found to influence the PR interval, compared to
other disease modifying antirheumatic drugs. Two PsA patients (2.1%) had a PR interval > 0.2
ms. Their prolonged PR interval could not be explained by medication use. The abnormal
prolongation of the PR interval was asymptomatic, requiring no additional intervention. No
patient had complete heart block. CONCLUSION: Our study may suggest subtle involvement
of the atrioventricular node in patients with PsA.
Endothelial dysfunction in psoriatic arthritis patients without

clinically evident cardiovascular disease or classic
atherosclerosis risk factors.
Arthritis Rheum. 2007; 57(2):287-93 (ISSN: 0004-3591)
Gonzalez-Juanatey C; Llorca J; Miranda-Filloy JA; Amigo-Diaz E; Testa A; Garcia-Porrua C;
Martin J; Gonzalez-Gay MA
Hospital Xeral-Calde, Lugo, Spain.
OBJECTIVE: To determine whether endothelial dysfunction was present in a cohort of

patients with psoriatic arthritis (PsA) without overt cardiovascular disease or classic
cardiovascular risk factors attended to in a community hospital. METHODS: Fifty patients
with PsA who fulfilled the Moll and Wright criteria were recruited from Hospital Xeral-Calde
(Lugo, Spain). Patients seen during the period of recruitment who had classic cardiovascular
risk factors or had experienced cardiovascular or cerebrovascular events were excluded. Fifty
healthy matched controls were also studied. In all patients and controls, endothelial function
was determined by measuring flow-mediated endothelial dependent vasodilatation (FMD%)
and endothelial independent vasodilatation (GTN%) by brachial ultrasonography. RESULTS:
FMD% was significantly impaired in patients compared with controls (mean, median [range]
6.3%, 6.1% [0.3-13.4%] versus 8.2%, 8.2% [0.0-21.2%]; P = 0.008). However, no significant
difference existed between patients and controls in GTN% or baseline diameter. A significant
correlation between C-reactive protein level and erythrocyte sedimentation rate at the time of
disease diagnosis and FMD% was found (P < 0.04). No significant FMD% and GTN%
differences were observed when patients with PsA with polyarticular pattern were compared
with the remaining patients with PsA. CONCLUSION: The present study demonstrates that
patients with PsA without cardiovascular risk factors or clinically evident cardiovascular
disease also exhibit endothelial dysfunction. These observations provide a basis for the
potential association between PsA and atherosclerotic disease.
Subclinical atherosclerosis in psoriatic arthritis: a case-

control study.
Eder L; Zisman D; Barzilai M; Laor A; Rahat M; Rozenbaum M; Bitterman H; Feld J; Rimar
D; Rosner I
Department of Internal Medicine, Carmel Medical Center, Lin Medical Center, Haifa, Israel.
benlihi@gmail.com
OBJECTIVE: To investigate the prevalence of subclinical atherosclerosis among patients with

psoriatic arthritis (PsA). METHODS: Forty patients with PsA were enrolled. Controls were
matched by age, sex, and atherosclerotic risk factors. All patients and controls underwent
duplex scan of the carotid arteries. Carotid intima-media thickness (IMT) was evaluated and
the presence of atherosclerotic plaques was recorded. The plaques were graded and carotid
plaque index was calculated. RESULTS: Patients with PsA had a higher IMT (mean +/-
standard deviation, 1.04 +/- 0.35 mm vs 0.88 +/- 0.29 mm in controls; p = 0.03), and had a
higher carotid plaque index than did matched controls (2.3 +/- 2.6, compared to 1.12 +/- 2.09;
p = 0.03). Multivariate analysis demonstrated that PsA status as well as age and triglyceride
levels were associated with the presence of carotid plaque. Other traditional risk factors were
more prevalent among patients with PsA; however, they were not statistically significant.
CONCLUSION: Our study demonstrates that patients with PsA may have an increased
prevalence of subclinical atherosclerosis. These findings may not be solely attributable to
traditional risk factors alone. Special attention and strict control of atherosclerotic risk factors
in patients with PsA is warranted.
[Cardiovascular risk in psoriatic arthritis]

Ter Arkh. 2009; 81(6):41-7 (ISSN: 0040-3660)
Badokin VV; Ianysheva AV; Aleksandrova EN; Mach ES; Popkova TV
AIM: To evaluate cardiovascular risk in psoriatic arthritis (PA). MATERIAL AND

METHODS: The examination covered 61 PA patients (52.9% females) aged 30-55 years and
45 controls without inflammatory and degeneratory diseases matched by gender, age and
body mass. Standard cardiovascular risk factors were analysed. C-reactive protein was
measured with a highly sensitive method. Carotid arteries were subjected to duplex scanning.
RESULTS: PA patients had a high cardiovascular risk. Dyslipidemia manifested with a high
total cholesterol, LDLP cholesterol which correlated with inflammation activity. PA was more
frequently associated with subclinical atherosclerosis and atherosclerotic plaques.
CONCLUSION: Chronic immune inflammation underlying pathogenesis of PA contributes to
development of early atherosclerosis and its complications. A high cardiovascular risk is a
constituent of PA which had an impact on long-term prognosis of this disease.
The heart damage in patients with psoriatic arthritis]

Ter Arkh. 2004; 76(5):56-61 (ISSN: 0040-3660)
Badokin VV; Kotel'nikova GP
AIM: To examine the rate and features of heart damage in psoriatic arthritis (PA) patients and
find out whether some parameters of PA are associated with cardiac involvement.
MATERIAL AND METHODS: The study enrolled 370 PA patients aged 15 to 72 years with
the disease history 1 to 44 years having different variants of the articular and skin syndromes.
The patients have undergone various tests including chest x-ray, ECG, echocardiography.
RESULTS: Myocarditis, adhesive pericarditis, valvular defects (mitral, aortic and combined
mitral-aortic were diagnosed in 15.9, 18.2 and 5.7% of PA patients, respectively). Aortitis was
detected in 51.3% patients with advanced sacroileitis and alkylosing spondylarthritis.
Alterations in the heart were associated with spinal lesions, other systemic manifestations,
activity of the disease and, in a lesser degree, with carriage of HLA-B27. CONCLUSION:
Cardiac syndrome in PA is characterized by marked heterogeneity and is one of basic
systemic manifestations of this disease. Latent PA aortatis can be detected at
echocardiography.
Subclinical carotid atherosclerosis in patients with psoriatic

arthritis.
Tam LS; Shang Q; Li EK; Tomlinson B; Chu TT; Li M; Leung YY; Kwok LW; Wong KC; Li
TK; Yu T; Zhu TY; Kun EW; Yip GW; Yu CM
The Prince of Wales Hospital and The Chinese University of Hong Kong, Hong Kong, China.
tamls_813@yahoo.com
OBJECTIVE: To examine the prevalence of subclinical atherosclerosis in patients with

psoriatic arthritis (PsA) compared with healthy controls, and to identify clinical and biologic
markers for atherosclerotic disease in this patient population. METHODS: Subclinical
atherosclerosis was defined as the average of intima-media thickness (IMT) measures in the
common carotid artery, bifurcation, and internal carotid artery on both sides above the 95th
percentile of healthy controls. IMT was measured using carotid ultrasonography in 82
consecutive PsA patients and 82 healthy controls matched on age, sex, and ethnicity. We also
ascertained traditional and novel cardiovascular (CV) risk factors, Framingham risk score
(FRS), disease severity, treatment, and inflammatory markers in all PsA patients. RESULTS:
No PsA patients had clinically overt CV diseases. After adjusting for traditional CV risk
factors, PsA patients had a higher prevalence of subclinical atherosclerosis. PsA patients with
subclinical atherosclerosis had significantly increased sugar, total triglyceride levels, total
cholesterol/high-density cholesterol, white cell count, and patients' global assessment score
compared with those without subclinical atherosclerosis. Using logistic regression analysis,
independent explanatory variables associated with subclinical atherosclerosis in PsA included
increased sugar and total triglyceride levels. The FRS was similar in PsA patients with or
without subclinical atherosclerosis. Twenty-six (35%) of 74 patients had subclinical
atherosclerosis despite having a low CV risk. CONCLUSION: PsA is associated with
subclinical atherosclerosis after adjusting for traditional CV risk factors. Independent
explanatory variables associated with subclinical atherosclerosis in PsA included increased
sugar and total triglyceride levels. Carotid IMT can identify PsA patients with subclinical
atherosclerosis who may benefit from early intervention.
High prevalence of subclinical atherosclerosis in psoriatic

arthritis patients without clinically evident cardiovascular
disease or classic atherosclerosis risk factors.
Gonzalez-Juanatey C; Llorca J; Amigo-Diaz E; Dierssen T; Martin J; Gonzalez-Gay MA
Hospital Xeral-Calde, Lugo, Spain.
OBJECTIVE: To assess the presence of subclinical atherosclerosis in patients with psoriatic

arthritis (PsA) without clinically evident atherosclerosis or its complications, and to assess
whether demographic or clinical factors affect the development of atherosclerotic disease in a
series of patients with PsA attended to in a community hospital. METHODS: Fifty-nine
patients with PsA who fulfilled the Moll and Wright criteria were recruited from Hospital
Xeral-Calde (Lugo, Spain). Patients seen during the period of recruitment who had classic
cardiovascular risk factors or had experienced cardiovascular or cerebrovascular events were
excluded. Fifty-nine healthy matched controls were also studied. Carotid artery intima-media
thickness (IMT) and carotid plaques were measured in the right common carotid artery. The
study was performed using high-resolution B-mode ultrasound. RESULTS: Patients with PsA
exhibited greater carotid artery IMT than did matched controls (mean +/- SD 0.699 +/- 0.165
mm versus 0.643 +/- 0.111 mm; P = 0.031; difference of means 0.056; 95% confidence
interval 0.005-0.108). Adjusted for age, the carotid IMT was correlated with age at the time of
PsA diagnosis (partial correlation coefficient [r] = -0.264, P = 0.04), disease duration (r =
0.264, P = 0.04), total cholesterol (r = 0.233, P = 0.01), and low-density lipoprotein
cholesterol (r = 0.243, P = 0.01). CONCLUSION: The present study demonstrates that
patients with PsA without cardiovascular risk factors or clinically evident cardiovascular
disease have a high prevalence of macrovascular disease in the form of increased carotid
artery IMT compared with ethnically matched controls.
Prevalence and risk factors of atherosclerosis in patients

Semin Arthritis Rheum. 2007; 36(4):203-9 (ISSN: 0049-0172)
Kimhi O; Caspi D; Bornstein NM; Maharshak N; Gur A; Arbel Y; Comaneshter D; Paran D;
Wigler I; Levartovsky D; Berliner S; Elkayam O
Department of Rheumatology, Tel Aviv Sourasky Medical Center, affiliated with the Sackler
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
OBJECTIVES: To evaluate the extent of subclinical atherosclerosis by measuring the intima-

media wall thickness (IMT) of the common carotid artery in patients with psoriatic arthritis
(PsA) and to identify vascular risk factors associated with PsA. METHODS: Forty-seven
patients with PsA were compared with 100 allegedly healthy subjects. Carotid duplex
scanning was used to measure common carotid artery IMT. Traditional risk factors, such as
gender, age, body mass index (BMI), hypertension, smoking, and lipids were checked.
Assessment of PsA activity included clinical patterns of involvement, degree of severity,
duration of morning stiffness, number of tender and swollen joints, degree of pain and fatigue,
the Bath Ankylosing Spondylitis Disease Activity Index, the Psoriasis Area and Severity
Index, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen.
RESULTS: The average IMT (mean +/- standard deviation) for PsA patients was significantly
higher compared with controls (0.76 +/- 0.11 versus 0.64 +/- 0.27, respectively, P < 0.00001)
for the whole group and after adjustment for age, gender, BMI, hypertension, and
hyperlipidemia. The PsA subjects had significantly higher levels of hypertension,
hyperlipidemia, ESR, CRP, and fibrinogen, and their average IMT significantly correlated
with age, BMI, duration of skin and joint disease, spine involvement, ESR, and fibrinogen.
IMT did not correlate with the presence of oligo- or polyarthritis but was increased in patients
with clinical spinal involvement. IMT was not associated with the degree of severity or the
use of different therapies for PsA, including methotrexate or tumor necrosis factor-alpha-
blocking agents. CONCLUSIONS: PsA patients exhibited greater IMT than healthy controls.
Increased IMT independently correlated with parameters of disease activity and conventional
risk factors of atherosclerosis.
Prevalence of cardiovascular diseases in psoriatic arthritis

resembles that of rheumatoid arthritis.
Jamnitski A; Visman IM; Peters MJ; Boers M; Dijkmans BA; Nurmohamed MT
Psoriatic arthritis criteria evaluation: CASPAR and Modified

CASPAR.
Clin Exp Rheumatol. 2011; 29(5):899-900 (ISSN: 0392-856X)
Zlatkovic-Svenda MI; Kerimovic-Morina D; Stojanovic RM
Role of asymptomatic hyperuricemia and serum uric acid

levels in the pathogenesis of subclinical atherosclerosis in
psoriatic arthritis: comment on the article by Chen et al.
Arthritis Rheum. 2009; 61(6):856-7; author reply 857-8 (ISSN: 0004-3591)
Gonzalez-Gay MA; Gonzalez-Juanatey C; Vazquez-Rodriguez TR; Dierssen T; Llorca J
Subclinical atherosclerosis in patients with psoriatic arthritis.

J Rheumatol. 2008; 35(10):2070-1; author reply 2071 (ISSN: 0315-162X)
Gonzalez-Gay MA; Vazquez-Rodriguez TR; Gonzalez-Juanatey C; Llorca J
Hypertriglyceridaemia during treatment with adalimumab in

psoriatic arthritis.
Br J Dermatol. 2007; 157(6):1273-4 (ISSN: 0007-0963)
Stinco G; Piccirillo F; Patrone P
Elevated triglyceride and cholesterol levels after intravenous

antitumour necrosis factor-alpha therapy in a patient with
psoriatic arthritis and psoriasis vulgaris.
Br J Dermatol. 2007; 156(5):1090-1 (ISSN: 0007-0963)
Antoniou C; Dessinioti C; Katsambas A; Stratigos AJ
High-density lipoprotein cholesterol in patients with psoriatic

arthritis.
J Eur Acad Dermatol Venereol. 2003; 17(3):362-3 (ISSN: 0926-9959)
Skoczyñska AH; Turczyn B; Barancewicz-Losek M; Martynowicz H
Cardiovascular involvement in psoriatic arthritis.

Reumatismo. 2011; 63(3):148-54 (ISSN: 0048-7449)
Atzeni F; Turiel M; Boccassini L; Sitia S; Tomasoni L; Battellino M; Marchesoni A; De
Gennaro Colonna V; Sarzi-Puttini P
Rheumatology Unit, L. Sacco University Hospital, Milan. sarzi@tiscali.it.
Psoriasis is a chronic, genetically determined and immunomediated inflammatory skin disease

that affects 2-3% of the Caucasian population. A considerable proportion of these patients
develop a form of inflammatory arthritis known as psoriatic arthritis (PsA), although the
prevalence of this has not been well defined. Patients with PsA have a higher mortality rate
than the general population and the risk of mortality is related to disease severity at the time
of presentation. Endothelial dysfunction and early atherosclerosis have been found in patients
with PsA without any cardiovascular disease (CVD) risk factors, and experts believe that
CVD is one of the leading causes of death, as it is in patients with rheumatoid arthritis (RA).
Various disease-related mechanisms may be involved in the development of premature
vascular damage in both cases, including an increased synthesis of proinflammatory
mediators (such as cytokines, chemokines and adhesion molecules), autoantibodies against
endothelial cell components, perturbations in T-cell subsets, genetic polymorphisms,
hyperhomocysteinemia, oxidative stress, abnormal vascular repair, and iatrogenic factors. In a
recent study of 22 patients with PsA without any signs of CVD, we found that the plasma
concentration of asymmetric dimethylarginine (ADMA) levels were significantly high and
coronary flow reserve (CFR) was significantly reduced. Moreover, there was a significant
correlation between CFR and plasma ADMA levels in the PsA group. The significant
correlation between the reduced CRF and increased ADMA levels suggests that, like patients
with early RA, PsA patients suffer from endothelial dysfunction and impaired coronary
microcirculation. Active PsA is a risk factor for CVD, and so PsA patients should be screened
for subclinical forms of the disease and its risk factors, and an early treatment approach
should be adopted.
Cardiovascular risk profile of patients with psoriatic arthritis

compared to controls--the role of inflammation.
Rheumatology (Oxford). 2008; 47(5):718-23 (ISSN: 1462-0332)
Tam LS; Tomlinson B; Chu TT; Li M; Leung YY; Kwok LW; Li TK; Yu T; Zhu YE; Wong
KC; Kun EW; Li EK
Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese
University of Hong Kong, Shatin, Hong Kong. tamls_813@yahoo.com
OBJECTIVE: To examine the distribution of traditional and novel risk factors of

cardiovascular disease (CVD) in patients with PsA compared with healthy controls.
METHODS: We compared risk factors for CVD between 102 consecutive PsA patients and
82 controls, adjusting for BMI. We also assessed the role of inflammation on the CVD risk
factor by using a BMI and high-sensitivity CRP (hsCRP)-adjusted model. RESULTS: The
BMI of PsA patients were significantly higher than healthy controls. After adjusting for the
BMI, PsA patients still have a higher prevalence of diabetes mellitus (DM) [odds ratio (OR)
9.27, 95% CI 2.09, 41.09) and hypertension (OR 3.37, 95% CI 1.68, 6.72), but a lower
prevalence of low high density lipoprotein (HDL) cholesterol (OR 0.16, 95% CI 0.07, 0.41).
PsA patients have significantly increased systolic and diastolic blood pressures, insulin
resistance and inflammatory markers (hsCRP and white cell count) compared to controls. PsA
patients have higher HDL cholesterol and apolipoprotein (Apo) A1 levels; and lower total
cholesterol (TC) and low density lipoprotein cholesterol levels; and a lower TC/HDL ratio.
However, the Apo B level (P < 0.05), and the Apo B/Apo A1 ratio (P = 0.07) were higher in
PsA patients. Further adjustment for hsCRP level rendered the differences in the prevalence of
hypertension and DM; the TC, and sugar levels; and white cell count non-significant between
the two groups; while the differences in other parameters remained significant.
CONCLUSION: These data support the hypothesis that PsA may be associated with obesity,
hypertension, dyslipidaemia and insulin resistance because of the shared inflammatory
pathway.
Cardiovascular risk in patients with psoriatic arthritis.

Int J Rheumatol. 2012; 2012:714321 (ISSN: 1687-9279)
Zhu TY; Li EK; Tam LS
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University
of Hong Kong, Shatin, N.T., Hong Kong.
Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis. In addition to

skin and joint involvement, there is increasing evidence suggesting that patients with PsA also
have an increase in risk of clinical and subclinical cardiovascular diseases, mostly due to
accelerating atherosclerosis. Both conventional and nonconventional cardiovascular risk
factors contribute to the increased cardiovascular risk in PsA. Chronic inflammation plays a
pivotal role in the pathogenesis of atherosclerosis in PsA, acting independently and/or
synergistically with the conventional risk factors. In this paper, we discuss the current
literature indicating that patients with PsA are at risk of cardiovascular diseases.
Obesity and psoriatic arthritis: from pathogenesis to clinical

outcome and management.
Russolillo A; Iervolino S; Peluso R; Lupoli R; Di Minno A; Pappone N; Di Minno MN
Department of Clinical and Experimental Medicine, Rheumatology Research Unit, 'Federico
II' University, Naples, Italy. rosario.peluso2@unina.it.
PsA is an axial and/or peripheral inflammatory arthritis associated with psoriasis, included in
the group of spondylarthritides. It has been suggested that PsA could be a systemic disease,
involving even coronary arteries and the heart. An increased prevalence of vascular risk
factors has been found in PsA subjects as compared with the general population and psoriatic
subjects. Moreover, PsA patients exhibit an increased prevalence of liver steatosis, a marker
of metabolic syndrome, and of obesity. Interestingly, many reports demonstrate that adipose
tissue is metabolically active, representing a source of inflammatory mediators, known as
adipokines. The latter include TNF-α, macrophage chemoattractant protein-1, plasminogen
activator inhibitor-1 (PAI-1), IL-6, leptin and adiponectin, leading to a pro-inflammatory
status in obese subjects. This evidence supports the idea of obesity as a low-grade
inflammatory disease. Accordingly, obesity might be associated with some rheumatic
diseases. In particular, it seems to affect several features of PsA, such as its development,
cardiovascular risk and clinical outcome. Recent data suggest that increased BMI in early
adulthood increases the risk of PsA development in psoriatic patients, supporting a link
between fat-mediated inflammation and joint involvement. Obesity may represent an additive
cardio-metabolic risk factor in PsA subjects. Abdominal obesity may also determine an
increased risk of not achieving minimal disease activity in PsA patients, highlighting the role
of abdominal fat accumulation as a negative predictor of good clinical response to biologic
agents. This review assesses the relationship between obesity and PsA according to the
available literature.
Decreased heart rate variability in patients with psoriatic

arthritis.
Gaydukova I; Rebrov A; Nikitina N; Poddubnyy D
Department of Hospital Therapy, Saratov State Medical University, Saratov, Russia.
The purpose of this study was to investigate autonomous regulation of the cardiac activity by
means of the heart rate variability (HRV) assessment and possible influence of conventional
cardiovascular risk factors and disease activity parameters on it in patients with psoriatic
arthritis (PsA). In total, 38 patients with the reliable diagnosis of PsA without clinically
manifest cardiovascular pathology, known rhythm or conduction disturbances, diabetes
mellitus, and hypercholesterolemia were included. In the control group, 25 age- and sex-
matched healthy persons comparable with PsA patients in cardiovascular risk profile were
included. For the HRV analysis, we used 5-min-long ECG records obtained at rest. Time and
frequency domain parameters of HRV were calculated. Patients with PsA had decreased HRV
in comparison to healthy controls as reflected by decrease of the standard deviation of normal
R-R intervals (65.1 ± 66.8 vs. 83.2 ± 43.3 ms, respectively, p = 0.011), of the percentage of
normal R-R intervals that differ by more than 50 ms (12.9 ± 15.4 vs. 20.6 ± 17.1 %,
respectively, p = 0.035), and of the total power (2,069.4 ± 1,537.8 vs. 2,942.5 ± 1,734.2 ms(2),
respectively, p = 0.006). A significant correlation of HRV parameters with disease duration
and parameters of disease activity in PsA was found. Patients with PsA had impaired
autonomous regulation of the cardiac activity, which is likely to be related to the presence of
systemic inflammation and which could contribute to the increase of cardiovascular risk in
this disease.
[Liver diseases in rheumatoid and psoriatic arthritis].

Acta Gastroenterol Latinoam. 2012; 42(2):112-9 (ISSN: 0300-9033)
Santiago García D; Saturansky E; Poncino D; Ortiz V; Martínez Artola Y; Rosenberg S;
Abritta G; Palermo C; Enriquez N; Cravero A
Servicio de Hepatología, Sanatorio Dr. Julio Méndez Ob. S. B. A. Ciudad Autónoma de
Buenos Aires, Argentina. dsgarcia@intramed.net
OBJECTIVE: The aim of this study was to evaluate the prevalence, risk factors and features
of liver diseases (LD) in rheumatoid and psoriatic arthritis.
PATIENTS AND METHODS: From July 2007 to January 2010, 118 non-selected patients
were consecutively examined. The assessment consisted of a medical record, biochemical
studies and abdominal ultrasounds. The diagnosis of fatty liver disease was based on the
ultrasound drug induced liver injury (DILI) was evaluated by the Maria-Victorino system
criteria. Liver biopsy associated with chronic administration of methotrexate was performed
using the histological classification of Kleiner et al. For the statistical analysis chi square test
with Yates correction, Student's t test or Mann-Whitney test were applied when appropriate. In
the multivariate analysis a binary logistic regression was used. The threshold of significance
was P < 0.05.
RESULTS: LD was diagnosed in 47 patients (39.8%). The most frequent LD was fatty liver
disease in 35 patients (29.7%), followed by DILI in 15 (12.7%), associated with non-steroidal
anti-inflammatory drugs (NSAID). In the multivariate analysis, obesity was the only
independent risk factor associated with fatty liver disease [Odds ratio (OR) 6.4 (confidence
interval (CI) 95%: 2.5-16.1; P = 0.000)] and fatty liver disease was the only risk factor
associated with DILI [OR 7.7 (CI 95%: 2.0-30.0; P = 0.003)].
CONCLUSIONS: In our series, there was a high prevalence of LD, being fatty liver disease
associated with obesity the most frequent finding. The second frequent disease was DILI,
being fatty liver disease its main risk factor. The presence of obesity and the use of NSAIDs,
especially in patients with steatosis, arise from our results as two conditions that require
special care in handling this particular population.
Increase in ventricular-arterial stiffness in patients with

psoriatic arthritis.
Shang Q; Tam LS; Sanderson JE; Sun JP; Li EK; Yu CM
Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of
Hong Kong, 9/F Clinical Sciences Building, Prince of Wales Hospital, Shatin, NT, Hong
Kong, China. cmyu@cuhk.edu.hk.
Objectives. Ventricular and arterial stiffness is an accepted cause of myocardial diastolic

dysfunction. The aim of this study is to determine whether there is increased ventricular and
arterial stiffness in patients with PsA and any relationship with disease-related risk factors.
Methods. Seventy-three patients with PsA were divided into two subgroups based on the
absence or presence of hypertension and/or left ventricular (LV) hypertrophy. Fifty healthy
controls were enrolled for comparison. All participants underwent non-invasive assessments
including conventional echocardiography with tissue Doppler imaging and pulse wave
analysis. Ventricular stiffness was measured by ventricular end-systolic and diastolic
elastance, whereas arterial stiffness was measured by total arterial compliance and aortic
augmentation index. Results. There was significantly increased ventricular and arterial
stiffness in patients with PsA (P < 0.001), even in those without hypertension and/or LV
hypertrophy. Based on the cut-off points derived from the controls, 38.4% of PsA patients had
increased LV stiffness including 31.5% in diastole and 17.8% in systole, and 15.1% had
increased arterial stiffness. Multivariable logistic regression analysis showed that long PsA
disease duration (>10 years) (odds ratio = 6.55, P = 0.001) was an independent risk factor for
increased LV diastolic elastance after adjusting for age, gender and hypertension. Conclusion.
Patients with PsA may have increased ventricular and arterial stiffness even without evidence
of LV remodelling, and those with long disease duration may be at a higher risk. Therefore,
prolonged inflammatory burden may be an important cause of early cardiovascular disease in
patients with PsA.
The therapeutic potential of TNF-alpha antagonists for skin

psoriasis comorbidities.
Expert Opin Biol Ther. 2010; 10(8):1197-208 (ISSN: 1744-7682)
Piérard GE; Piérard-Franchimont C; Szepetiuk G; Paquet P; Quatresooz P
University Hospital Sart Tilman, Department of Dermatopathology, Liège, Belgium.
gerald.pierard@ulg.ac.be
IMPORTANCE OF THE FIELD: Alopecia, psoriatic arthritis, the metabolic syndrome,

inflammatory bowel diseases and cardiovascular diseases may occur as skin psoriatic
comorbidities. TNF-alpha antagonists are used to treat psoriasis. Adalimumab is one of the
recognized active agents for this indication. AREAS COVERED IN THIS REVIEW: The
current peer-reviewed publications and presentation of original findings. WHAT THE
READER WILL GAIN: Adalimumab is active on recalcitrant psoriasis and some of its
comorbidities, particularly arthropathies and Crohn's disease. However, the progression of the
radiological alterations is limited with regression of the bony erosions. Psoriatic enthesopathy
also regresses. Mortality associated with psoriasis arthropathy is on the decline. Crohn's
disease, the most frequent inflammatory bowel comorbidity of psoriasis, is responsive to
adalimumab. The effect of adalimumab on the metabolic syndrome and cardiovascular
involvement is more erratic. The spectacular effects of adalimumab may be associated with
some adverse effects. In particular, despite a marked reduction in the psoriasis area-and-
severity index (PASI) score some new acute lesions of cutaneous psoriasis may develop
corresponding to paradoxical psoriasis. Other potential adverse effects include infections,
granulomas, rapid growth of cancers and occurrence of lymphomas. TAKE HOME
MESSAGE: Adalimumab frequently controls moderate-to-severe forms of cutaneous
psoriasis and some of its comorbidities.
Asymmetric dimethylarginine (ADMA) as a risk marker for stroke and

TIA in a Swedish population
 P. Wanby
 T. Teerlink
,
 L. Brudin
,
 L. Brattström
,
 I. Nilsson
,
 P. Palmqvist
,
 M. Carlsson
Received 13 April 2005; received in revised form 8 June 2005; accepted 21 June 2005. published
online 01 August 2005.
 Abstract
 Full Text
 PDF
 References
Abstract
Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, has
been shown to be involved in the pathogenesis of atherosclerosis. The present study was
initiated to investigate the role of ADMA as a risk marker of acute cerebrovascular disease
(CVD).
We examined 363 CVD patients and 48 controls. The ADMA concentration (mean ± S.D.,
μmol/L) in controls was 0.50 ± 0.06. Compared to controls, increased concentrations of
ADMA were observed in cardio-embolic infarction (0.55 ± 0.08; p < 0.001; n = 71), and TIA
(0.54 ± 0.05; p < 0.001; n = 31), but not in non-cardio-embolic infarction (0.51 ± 0.07; p =
0.56; n = 239) and haemorrhagic stroke (0.51 ± 0.11; p = 0.77; n = 22). In multivariate logistic
regression models, CVD increased across quartiles of ADMA in all subgroups, but this
association was only significant in the TIA group (odds ratio for highest versus lowest
quartile 13.1; 95% CI: 2.9–58.6; p trend 0.001) A decreased arginine/ADMA ratio was
significantly associated with CVD in the entire study population ( p < 0.01). Our results
indicate that ADMA is a weak independent marker for acute stroke and a strong marker for
TIA and that relative arginine deficiency, measured as the L-arginine/ADMA ratio, is present
in acute CVD.

J Rheumatol. 2010 37 (7) :1386-94: (ISSN: 0315-162X)

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J Rheumatol. 2010 37 (7) :1386-94: (ISSN: 0315-162X)

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Cardiovascular disease and risk factors in patients with

psoriasis and psoriatic arthritis.

Cardiovascular risk factors in psoriatic and rheumatoid

CONCLUSION: To determine cardiovascular risk in patients with arthritis, it is necessary to

Effects of anti-TNF therapy on glucose metabolism in

Risk of diabetes among patients with rheumatoid arthritis,

CONCLUSIONS: RA and PsA/PsO appear to be associated with an increased risk of DM.

Cardiovascular comorbidities in psoriasis and psoriatic

Coronary flow reserve and asymmetric dimethylarginine

OBJECTIVE: To identify the presence of subclinical atherosclerosis in patients with psoriatic

CONCLUSION: Our patients with PsA showed a profile of subclinical atherosclerosis.

Cardiovascular mortality in psoriasis and psoriatic arthritis:

Comorbidities of psoriatic arthritis -- metabolic syndrome

Psoriatic arthritis (PsA) is associated with serious comorbidities such as increased

Update on biomarkers in psoriatic arthritis: a report from the

The association between smoking and the development of

[Subclinical atherosclerosis in patients with psoriatic

Atherosclerosis in psoriatic arthritis.

The atherosclerotic process is accelerated in several autoimmune rheumatic diseases. Effector

Psoriatic arthritis is associated with increased arterial

Cardiovascular and metabolic risks in psoriasis and psoriatic

High prevalence of subclinical left ventricular dysfunction in

Obesity and the risk of psoriatic arthritis: a population-based

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Cardiovascular disease and risk factors in patients with

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CONCLUSION: It remains difficult to conclude if risk factors are caused by psoriasis or

Asymptomatic hyperuricemia and serum uric acid

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Mortality in psoriatic arthritis - a single-center study from the

Cardiovascular morbidity in psoriatic arthritis.

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Psoriatic arthritis and spondyloarthritis (SpA) are complex immune-mediated diseases

Increased prevalence of the metabolic syndrome in patients

OBJECTIVES: Psoriasis (PsO) is a common chronic T cell-mediated inflammatory disorder

RESULTS: Our results demonstrated an increased prevalence of the metabolic syndrome in

The metabolic syndrome predicts cardiovascular events: results of a 13-year

Vakil KP; Malhotra S; Sawada S; Campbell SR; Sayfo S; Kamalesh M

Electrocardiographic abnormalities associated with the metabolic syndrome and

Optimal uric acid threshold to identify insulin resistance in healthy women.

Yazıcı D; Yavuz D; Öğünç AV; Sirikçi Ö; Toprak A; Deyneli O; Akalın S

Increased waist circumference is the component of metabolic syndrome the most

Increased prevalence of the metabolic syndrome in patients

OBJECTIVES: Psoriasis (PsO) is a common chronic T cell-mediated inflammatory disorder

RESULTS: Our results demonstrated an increased prevalence of the metabolic syndrome in

A study of intima media thickness and their cardiovascular

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Cardiovascular risk profile of patients with

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Measurement of disease activity in psoriatic arthritis.

OBJECTIVE: To determine whether activity indices, generally accepted in rheumatoid

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Psoriatic arthritis as a distinct disease entity.

Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease characterized by joint

Protein oxidation markers in the serum and synovial fluid of

Evaluation of oxidative stress in rheumatoid and psoriatic

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Cardiovascular disease and risk factors in patients with

Laboratory findings in psoriatic arthritis.

Metabolic disorders in patients with psoriasis and psoriatic

Psoriasis is one of the common complex disorders in Western world, affecting 2% to 3% of

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Endothelial dysfunction in psoriatic arthritis patients without