Cardiovascular involvement in psoriatic arthritis

  • F. Atzeni Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.
  • M. Turiel Cardiology Unit, Department of Health Technologies, IRCCS Galeazzi Orthopedic Institute, Università di Milano, Milan, Italy.
  • L. Boccassini Rheumatology Unit, L. Sacco University Hospital, Milan, .
  • S. Sitia Cardiology Unit, Department of Health Technologies, IRCCS Galeazzi Orthopedic Institute, Università di Milano, Milan, Italy.
  • L. Tomasoni Cardiology Unit, Department of Health Technologies, IRCCS Galeazzi Orthopedic Institute, Università di Milano, Milan, Italy.
  • M. Battellino Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.
  • A. Marchesoni U.O.C. Day Hospital of Rheumatology, Pini Orthopedic Institute, Milan, Italy.
  • V. De Gennaro Colonna Department of Pharmacology, Chemotherapy and Medical Toxicology, University of Milan, Italy.
  • P. Sarzi-Puttini | sarzi@tiscali.it Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.

Abstract

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.

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Published
2011-11-09
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Section
Reviews
Keywords:
psoriatic arthritis, cardiovascular involvement, asymmetric dimethylarginine, risk factors
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How to Cite
Atzeni, F., Turiel, M., Boccassini, L., Sitia, S., Tomasoni, L., Battellino, M., Marchesoni, A., De Gennaro Colonna, V., & Sarzi-Puttini, P. (2011). Cardiovascular involvement in psoriatic arthritis. Reumatismo, 63(3), 148-154. https://doi.org/10.4081/reumatismo.2011.148

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