Int J Angiol
DOI: 10.1055/s-0036-1584918
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Atherosclerosis in Psoriatic Arthritis: A Multiparametric Analysis Using Imaging Technique and Laboratory Markers of Inflammation and Vascular Function

Nidhi Garg
1   Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
Pawan Krishan
1   Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
Ashit Syngle
2   Cardio Rheuma and Healing Touch City Clinic, Chandigarh and Rheumatologist, Fortis Multispecialty Hospital, Mohali, Punjab, India
› Author Affiliations
Further Information

Publication History

Publication Date:
01 July 2016 (online)


Cardiovascular disease is one of the leading causes of death in psoriatic arthritis (PsA). Pathogenesis of accelerated atherosclerosis in PsA remains to be elucidated. Endothelial dysfunction (ED) often precedes manifesting atherosclerosis. This study aims to assess carotid intima-media thickness (CIMT), a marker of atherosclerosis in PsA, in context of markers of inflammation and vascular function. A cross-sectional study was performed in 18 PsA patients who were compared with 18 controls matched for age and sex. Flow-mediated dilatation (FMD) assessed by AngioDefender (Everist Health, Ann Arbor, MI), endothelial progenitor cells (EPCs) quantified by flow cytometry and CIMT measured ultrasonographically. Inflammatory measures included disease activity score of 28 joints count and disease activity index in psoriatic arthritis. We also assayed markers of inflammation, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), proinflammatory cytokines (interleukin [IL]-1, IL-6, and tumor necrosis factor [TNF]-α), and endothelial dysfunction, including lipids, intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and EPCs. CIMT is significantly higher in PsA patients compared with controls (0.062 ± 0.18 vs. 0.045 ± 0.10 cm, p < 0.01) whereas FMD%, EPCs%, and high-density lipoproteins (HDL) cholesterol are significantly reduced in PsA compared with controls (p < 0.05). Compared with controls, PsA patients had significantly increased concentrations of ESR, CRP, TNF-α, IL-6, ICAM-1, and VCAM-1. In PsA, CIMT positively correlated with IL-6 and ICAM-1 and inversely correlated with FMD, HDL, and EPCs (p < 0.05). In PsA, FMD and CIMT were impaired, indicating endothelial dysfunction and accelerated atherosclerosis, respectively. PsA-related inflammatory mechanisms (TNF-α, IL-6) and markers of vascular function (CRP, ICAM-1, and EPCs) may all be involved in the development of vascular disease in PsA. Cytokine-triggered inflammation upregulates expression of adhesion molecules, depletes EPCs with endothelial dysfunction, and increased CIMT in PsA.

  • References

  • 1 Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005; 64 (Suppl. 02) ii14-ii17
  • 2 Wong K, Gladman DD, Husted J, Long JA, Farewell VT. Mortality studies in psoriatic arthritis: results from a single outpatient clinic. I. Causes and risk of death. Arthritis Rheum 1997; 40 (10) 1868-1872
  • 3 Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, Nurmohamed MT. Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum 2004; 34 (3) 585-592
  • 4 Kölliker Frers RA, Bisoendial RJ, Montoya SF , et al. Psoriasis and cardiovascular risk: Immune-mediated crosstalk between metabolic, vascular and autoimmune inflammation. IJC Metab Endocr 2015; 6: 43-54
  • 5 Kimhi O, Caspi D, Bornstein NM , et al. Prevalence and risk factors of atherosclerosis in patients with psoriatic arthritis. Semin Arthritis Rheum 2007; 36 (4) 203-209
  • 6 Di Minno MND, Ambrosino P, Lupoli R , et al. Cardiovascular risk markers in patients with psoriatic arthritis: A meta-analysis of literature studies. Ann Med 2015; 47 (4) 346-353
  • 7 Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H ; CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006; 54 (8) 2665-2673
  • 8 Huang K, Zou CC, Yang XZ, Chen XQ, Liang L. Carotid intima-media thickness and serum endothelial marker levels in obese children with metabolic syndrome. Arch Pediatr Adolesc Med 2010; 164 (9) 846-851
  • 9 Garg N, Krishan P, Syngle A. Rosuvastatin improves endothelial dysfunction in ankylosing spondylitis. Clin Rheumatol 2015; 34 (6) 1065-1071
  • 10 Allanore Y, Batteux F, Avouac J, Assous N, Weill B, Kahan A. Levels of circulating endothelial progenitor cells in systemic sclerosis. Clin Exp Rheumatol 2007; 25 (1) 60-66
  • 11 Herbrig K, Haensel S, Oelschlaegel U, Pistrosch F, Foerster S, Passauer J. Endothelial dysfunction in patients with rheumatoid arthritis is associated with a reduced number and impaired function of endothelial progenitor cells. Ann Rheum Dis 2006; 65 (2) 157-163
  • 12 Gonzalez-Juanatey C, Llorca J, Amigo-Diaz E, Dierssen T, Martin J, Gonzalez-Gay MA. High prevalence of subclinical atherosclerosis in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum 2007; 57 (6) 1074-1080
  • 13 Gonzalez-Juanatey C, Llorca J, Testa A, Revuelta J, Garcia-Porrua C, Gonzalez-Gay MA. Increased prevalence of severe subclinical atherosclerotic findings in long-term treated rheumatoid arthritis patients without clinically evident atherosclerotic disease. Medicine (Baltimore) 2003; 82 (6) 407-413
  • 14 Salmon JE, Roman MJ. Subclinical atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus. Am J Med 2008; 121 (10) (Suppl. 01) S3-S8
  • 15 Verma I, Krishan P, Syngle A. Predictors of Atherosclerosis in Ankylosing Spondylitis. Rheumatol Ther 2015; 2: 173-182
  • 16 Puato M, Ramonda R, Doria A , et al. Impact of hypertension on vascular remodeling in patients with psoriatic arthritis. J Hum Hypertens 2014; 28 (2) 105-110
  • 17 Eder L, Zisman D, Barzilai M , et al. Subclinical atherosclerosis in psoriatic arthritis: a case-control study. J Rheumatol 2008; 35 (5) 877-882
  • 18 Bots ML, Grobbee DE. Intima media thickness as a surrogate marker for generalised atherosclerosis. Cardiovasc Drugs Ther 2002; 16 (4) 341-351
  • 19 Atzeni F, Sarzi-Puttini P, Sitia S , et al. Coronary flow reserve and asymmetric dimethylarginine levels: new measurements for identifying subclinical atherosclerosis in patients with psoriatic arthritis. J Rheumatol 2011; 38 (8) 1661-1664
  • 20 Magro-Checa C, Orgaz-Molina J, Rosales-Alexander JL , et al. Comparison of subclinical carotid atherosclerosis in patients with psoriatic arthritis, psoriasis alone and controls. Ann Rheum Dis 2013; 71: 572
  • 21 Grisar J, Aletaha D, Steiner CW , et al. Depletion of endothelial progenitor cells in the peripheral blood of patients with rheumatoid arthritis. Circulation 2005; 111 (2) 204-211
  • 22 Del Papa N, Quirici N, Soligo D , et al. Bone marrow endothelial progenitors are defective in systemic sclerosis. Arthritis Rheum 2006; 54 (8) 2605-2615
  • 23 Verma I, Syngle A, Krishan P. Endothelial dysfunction in ankylosing spondylitis associated with reduced endothelial progenitor cell population. IJRCI 2015; 3 (1) OA3
  • 24 Vasa M, Fichtlscherer S, Aicher A , et al. Number and migratory activity of circulating endothelial progenitor cells inversely correlate with risk factors for coronary artery disease. Circ Res 2001; 89 (1) E1-E7
  • 25 Schmidt-Lucke C, Rössig L, Fichtlscherer S , et al. Reduced number of circulating endothelial progenitor cells predicts future cardiovascular events: proof of concept for the clinical importance of endogenous vascular repair. Circulation 2005; 111 (22) 2981-2987
  • 26 Gonzalez-Juanatey C, Llorca J, Miranda-Filloy JA , et al. Endothelial dysfunction in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum 2007; 57 (2) 287-293
  • 27 Altekin ER, Koç S, Karakaş MS , et al. Determination of subclinical atherosclerosis in plaque type psoriasis patients without traditional risk factors for atherosclerosis. Turk Kardiyol Dern Ars 2012; 40 (7) 574-580
  • 28 Verma S, Wang CH, Li SH , et al. A self-fulfilling prophecy: C-reactive protein attenuates nitric oxide production and inhibits angiogenesis. Circulation 2002; 106 (8) 913-919
  • 29 Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340 (6) 448-454
  • 30 Alenius GM, Eriksson C, Rantapää Dahlqvist S. Interleukin-6 and soluble interleukin-2 receptor alpha-markers of inflammation in patients with psoriatic arthritis?. Clin Exp Rheumatol 2009; 27 (1) 120-123
  • 31 Sattar N, McCarey DW, Capell H, McInnes IB. Explaining how “high-grade” systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation 2003; 108 (24) 2957-2963
  • 32 Sattar N, Crompton P, Cherry L, Kane D, Lowe G, McInnes IB. Effects of tumor necrosis factor blockade on cardiovascular risk factors in psoriatic arthritis: a double-blind, placebo-controlled study. Arthritis Rheum 2007; 56 (3) 831-839
  • 33 Hughes M, Chinoy H. Successful use of tocilizumab in a patient with psoriatic arthritis. Rheumatology (Oxford) 2013; 52 (9) 1728-1729
  • 34 Riccieri V, Spadaro A, Taccari E , et al. Adhesion molecule expression in the synovial membrane of psoriatic arthritis. Ann Rheum Dis 2002; 61 (6) 569-570
  • 35 Poston RN, Haskard DO, Coucher JR, Gall NP, Johnson-Tidey RR. Expression of intercellular adhesion molecule-1 in atherosclerotic plaques. Am J Pathol 1992; 140 (3) 665-673
  • 36 Dessein PH, Joffe BI, Singh S. Biomarkers of endothelial dysfunction, cardiovascular risk factors and atherosclerosis in rheumatoid arthritis. Arthritis Res Ther 2005; 7 (3) R634-R643
  • 37 Rho YH, Chung CP, Oeser A , et al. Inflammatory mediators and premature coronary atherosclerosis in rheumatoid arthritis. Arthritis Rheum 2009; 61 (11) 1580-1585
  • 38 Tam LS, Tomlinson B, Chu TT , et al. Cardiovascular risk profile of patients with psoriatic arthritis compared to controls—the role of inflammation. Rheumatology (Oxford) 2008; 47 (5) 718-723