Cardiovascular risk in psoriatic arthritis: How can we manage it?

Abstract

It is now widely recognized that patients with psoriatic arthritis (PsA) have a higher risk of cardiovascular disease (CVD) when compared with the general population. A number of factors contribute to this increased risk. Skin and articular inflammation have been shown to be independently associated with CVD in PsA patients. Metabolic syndrome and all its components are significantly more frequent in PsA patients than in healthy populations. Depression, which is not uncommon in psoriatic subjects, seems to increase the CV risk. Finally, corticosteroids and non-steroidal anti-inflammatory drugs, which are often used for the treatment of PsA, have a well-known pro-atherosclerotic effect.

Therefore, in PsA patients the CV risk should be regularly estimated, using validated scoring instruments and appropriate techniques of vascular assessment when needed. Instrument choice and usefulness in PsA populations are still under debate. Patients at high risk should be treated addressing all the risk factors and tightly monitored. Abrogation or, at least, reduction of skin and articular inflammation, appropriate treatment of the metabolic abnormalities, and modifications of unhealthy life habits are the measures that can substantially improve the CV outcome of the patients with PsA. Cooperation of different specialists may be needed to optimize the management of the individual patient. Artificial intelligence applications, novel biomarkers and new care approaches, including treatment strategies and decision-making processes, may be considered in the PsA setting.