OA13 A study on subclinical atherosclerosis in Indian patients with psoriatic arthritis
Authors: Yadavalli Durgarao , Ghosh Shounak , Dhuria Shahzeene , Telang Kaustubh , Sharma Lucky , Bajaj Rohit , Singal Vinay , Gupta Rajiva 
Published: April 2023

Abstract

Background/Aims
Psoriatic Arthritis (PsA) is a type of chronic inflammatory arthritis with diverse extra-articular manifestations and complications, including an increased burden of cardiovascular (CV) disease. Traditional CV risk factors are more common in PsA patients, leading to not only overt but also subclinical CV disease. Endothelial dysfunction and altered handling of low-density lipoproteins (LDL) lead to atherogenesis. Oxidized LDL (Ox-LDL) and antibodies against it (Anti Ox-LDL) may reflect the in vivo inflammatory burden in systemic vasculature in PsA. This study aimed to assess subclinical atherosclerosis in PsA patients and compare them with healthy controls, by assessing carotid intimal medial thickness (CIMT) and laboratory surrogates of dyslipidemia.

Methods
This was a cross-sectional, case-control study. Between January 2019 and May 2020, adult patients classified as PsA as per the CASPAR criteria, with symptom duration of at least 2 years, were included in this study. An equal number of age- and gender-matched controls were enrolled. We excluded patients on lipid-lowering drugs for more than the past 3 months. Demographic details, clinical and laboratory parameters (including Ox-LDL and Anti Ox-LDL antibodies), and bilateral CIMT assessment using B-mode Doppler Ultrasonography by a single, blinded cardiologist, were assessed for each participant. The study was approved by the Institutional Ethics Committee.

Results
Fifty PsA patients consented to the study, with a median age of 43.92 ± 10.79 years. Fifty healthy controls were also enrolled. 57% of the cases were male, with plaque psoriasis in 94%, and polyarthritis in 54%. Compared to the controls, PsA patients had significantly higher mean body mass index (BMI, 26.5 vs 24.6, p = 0.004), mean VLDL (25.6 mg/dl vs 20.5 mg/dl, p = 0.01), mean bilateral CIMT (0.62 mm vs 0.46 mm, p &lt; 0.001), and mean Anti Ox-LDL antibody levels (29 U/ml vs 22.4 U/ml, p &lt; 0.001). There was a significantly greater proportion of PsA patients with total cholesterol to HDL ratio &gt;3.5 (86% vs 68%, p = 0.03), obesity (18% vs 6%, p = 0.01), and Anti Ox-LDL &gt;30 U/ml (32% vs 6%, p = 0.02). CIMT and Anti Ox-LDL levels did not show any significant correlation. Univariate and multivariate analyses revealed that older patient age, total cholesterol level, and presence of PsA were risk factors for increased mean CIMT as a proxy for subclinical atherosclerosis.

Conclusion
This study used a novel biomarker, the Anti-Ox-LDL antibody, as a proposed surrogate marker for atherosclerotic risk stratification in patients with PsA. To our knowledge, this is the first such study in PsA. We found an increased prevalence of subclinical atherosclerosis in PsA patients compared to age- and gender-matched healthy controls. Age, total cholesterol levels, and the presence of PsA were independent predictors of atherosclerotic risk. Anti-Ox-LDL antibodies are significantly elevated in PsA patients compared to controls, but they may not correlate well with CIMT values.
Disclosure
D. Yadavalli: None. S. Ghosh: None. S. Dhuria: None. K. Telang: None. L. Sharma: None. R. Bajaj: None. V. Singal: None. R. Gupta: None.