POS0977 CARDIOVASCULAR AND DISEASE RELATED FEATURES IN AXIAL SPONDYLITIS WITH AND WITHOUT CONCOMITANT PSORIASIS. A MULTICENTER STUDY WITH 882 PATIENTS
Authors: I. González-Mazón, J. Rueda-Gotor, I. Ferraz-Amaro, L. Sanchez-Bilbao, F. Genre, V. Calvo-Río, S. Remuzgo-Martínez, V. Pulito-Cueto, A. Corrales, L. Lera-Gómez, V. Portilla, V. Hernández-Hernández, J. C. Quevedo-Abeledo, C. Rodríguez-Lozano, C. López-Medina, M. L. Ladehesa Pineda, S. Castañeda, E. F. Vicente-Rabaneda, C. Fernández-Carballido, M. P. Martínez-Vidal, D. Castro-Corredor, J. Anino-Fernández, D. Peiteado, C. Plasencia, M. L. García Vivar, E. Galindez, E. Montes Pérez, C. Fernández-Díaz, R. Blanco, M. A. González-Gay
Journal: Annals of the Rheumatic Diseases (2021)

Background: Patients with axial spondyloarthritis (axSpA) may present with concomitant psoriasis (Ps) in approximately 10% of cases. As with axSpA, Ps is also associated with an accelerated atherosclerosis process 1 . However, it is unknown whether the presence of Ps confers an increased cardiovascular (CV) risk in patients with axSpA. Objectives: To compare factors related to the disease, CV risk factors, atherosclerotic burden, and CV events in patients with axSpA with and without Ps. Methods: Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA. We compared axSpA patients with and without concomitant psoriasis, focusing mainly on CV risk characteristics. Background information on CV risk factors, CV events, and disease-related factors was reviewed, and data on maximum body index, blood pressure, lipid profile, and disease status at the time of the study were also obtained. Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria. Results: A set of 882 axSpA patients were included. 786 (89.1%) of them had no concomitant Ps, which was present in 96 (10.9%) patients. Although the mean age was similar, male sex was more prevalent in axSpA patients with Ps (79.1% Vs 66.5%, p=0.01) (Table 1). Furthermore, it was found that axSpA with Ps had a more frequent history of synovitis (50% vs 33%, p = 0.001), dactylitis (13% vs 6%, p = 0.011) and concomitant inflammatory bowel disease (13% vs 6%, p = 0.01). AxSpA patients with Ps had a non-significant trend towards a higher prevalence of asymmetric sacroiliitis (23 vs 16%, p = 0.064) and had a lower frequency of positive HLA-B27 status (56% vs 72%, p = 0.003). Regarding the management of the disease, prednisone (23% vs 12%, p = 0.02), methotrexate (30% vs 15%, p = 0.000) and anti-TNFα therapy (50% vs 34%, p = 0.002) were more commonly used in the group with Ps. Regarding CV risk characteristics, no differences were observed either in the prevalence of traditional CV risk factors (Table 1), nor in the total serum level, HDL and LDL, blood pressure and body mass index at that time of the study. However, axSpA patients with Ps showed a higher prevalence of CV events (9% vs 4%, p = 0.05), including ischemic heart disease (6% vs 3%, p = 0.042) and ischemic stroke (4% vs 1%, p = 0.016) (Table 1). The subclinical atherogenic burden was also more severe in the group with Ps, with a higher prevalence of carotid plaques (39% vs 31%, p = 0.098), and higher values of cIMT (0.664 ± 0.170 mm vs 0.642 ± 0.142 mm, p = 0.16), although the differences did not reach statistical significance. Table 1. Main sociodemographic and cardiovascular differences among axSpA patients with and without psoriasis. axSpA without psoriasis (n=786 ) axSpA with psoriasis (n=96 ) p Men/Women, n 523/268 76/20 0.010 Mean age (years) ±SD at the time of study 49 ± 13 49 ± 13 0.81 AS/nr-AxSpa 625/166 77/19 0.79 History of CV risk factors Current smokers 267 (34) 30 (31) 0.60 Obesitty 174 (22) 26 (27) 0.29 Dyslipidemia 262 (33) 35 (36) 0.48 Hypertension 211 (27) 28 (29) 0.57 Diabetes Mellitus 56 (7) 8 (8) 0.65 Chronic Kidney Disease 19 (2) 3 (3) 0.72 History of cardiovascular events, n (% ) 33 (4) 9 (9) 0.023 Ischemic heart disease 20 (3) 6 (6) 0.042 Congestive heart failure 2 (0) 1 (1) 0.29 Ischemic stroke 6 (1) 4 (4) 0.016 Peripheral artery disease 6 (1) 0 (0) 0.99 CV data at the time of study Carotid plaques 244 (31) 38 (39) 0.098 IMT mm 0.642 ± 0.142 0.664 ± 0.170 0.16 IMT &gt;= 900 mm 40 (5) 6 (6) 0.66 Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis. Conclusion: The presence of Ps may confer additional CV risk to axSpA patients and is associated with particular disease related factors. References: [1]Fang N, Jiang M, Fan Y. Association Between Psoriasis and Subclinical Atherosclerosis: A Meta-Analysis. Medicine (Baltimore ). 2016;95(20):e3576. Disclosure of Interests: None declared.