Metabolic Syndrome Presents Differently in Rheumatoid, Psoriatic Arthritis

The impact of metabolic syndrome (MetS) along with its components displayed differently in patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA), with the link between risk factors and cardiovascular events presenting stronger in PsA compared with RA. Investigators believe these findings suggest different mechanisms and reveal a need for distinct strategies to prevent cardiovascular events in these patient populations, according to a study published in Journal of Clinical Medicine.¹

Fabiola Atzeni, MD

Credit: MediFind

RA is linked to an increased risk of cardiovascular morbidity and is considered an independent risk factor for cardiovascular disease (CVD). Similarly, patients with PsA are at an increased risk of cardiovascular and cerebrovascular events when compared with the general population. This is likely due to a combination of chronic systemic inflammation, side effects of certain medications, and traditional risk factors for CVD, which include hypertension, dyslipidemia, diabetes, smoking, older age, and male gender.²

“Overall, the epidemiologic evidence confirms the association between chronic inflammatory joint diseases and traditional cardiovascular risk factors and suggests that this association may differ among diseases,” wrote Fabiola Atzeni, MD, Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Italy, and colleagues. “These differences need to be further investigated as they may have an impact on the prevention and management of cardiovascular disease in RA and PsA.”

To compare the prevalence of MetS and the impact it has on the cardiovascular disease in RA and PsA, a retrospective analysis of real-world data of patients referred to a tertiary level rheumatology clinic was performed. Demographic and clinical data, the presence of traditional cardiovascular risk factors, and MetS diagnosis were collected at baseline and patients were followed-up for an additional 12 months. Both univariate and multivariate models compared the impact of MetS and its factors in both arthritis groups.

In total, 170 patients were analyzed, including 78 patients with PsA and 92 patients with RA. Although most variables were comparable, patients in the PsA cohort were younger and reported a shorter disease duration. MetS was reported in 51.3% of patients with PsA compared with 27.2% of patients with RA (P = .002), and 71.8% of patients in the PsA cohort had dyslipidemia compared with 28.3% of patients with RA (P <.001). The history of cardiovascular events was comparable between both groups.

Analysis revealed hypertension in PsA and dyslipidemia in RA as distinct predictors of MetS. Cardiovascular events were predicted by MetS and most of its components in patients with PsA, while dyslipidemia was the strongest predictor in patients with RA. However, associations were stronger in PsA when compared with RA, which were validated by the greater coefficient of determination in the PsA cohort.

Investigators noted the retrospective design coupled with the relatively small sample size of the cohorts as limitations of the study. The groups were not matched regarding disease duration or age, due to factors such as the different pathogenesis and age of onset. Another potential limitation was not including strict clinical features as inclusion or exclusion criteria. However, this approach was taken to better capture real-world populations and avoid overly selected patient samples.

“These findings are relevant for clinical practice as a disease-specific management of cardiovascular risk may be required in distinct chronic inflammatory diseases of the joints,” investigators concluded. “However, clinical validation in larger studies is needed. Further efforts are required to develop disease-specific strategies for the management of cardiovascular risk in PsA and RA.”

References

1. ^{Atzeni F, La Corte L, Cirillo M, Giallanza M, Galloway J, Rodríguez-Carrio J. Metabolic Syndrome and Its Components Have a Different Presentation and Impact as Cardiovascular Risk Factors in Psoriatic and Rheumatoid Arthritis. J Clin Med. 2023;12(15):5031. Published 2023 Jul 31. doi:10.3390/jcm12155031}
2. ^{Symmons, D.P.; Gabriel, S.E. Epidemiology of CVD in rheumatic disease, with a focus on RA and SLE. Nat. Rev. Rheumatol. 2011, 7, 399–408}