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By Nancy Walsh, Staff Writer, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse PlannerThis study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.High disease activity in psoriatic arthritis is associated with elevated total cholesterol and triglycerides, adding to a growing body of evidence linking psoriatic arthritis metabolically with dyslipidemia and obesity.Note that the study suggests that there may be common pathogenic mechanisms for obesity and psoriatic arthritis.MADRID -- High disease activity in psoriatic arthritis is associated with elevated total cholesterol and triglycerides, adding to a growing body of evidence linking psoriatic arthritis metabolically with dyslipidemia and obesity, a researcher said here.
Patients considered to have high disease activity because of scores of 10 or higher on the Clinical Disease Activity Index, or the presence of enthesitis or dactylitis, were significantly more likely to have total cholesterol levels above 200 mg/dL (odds ratio 1.58, 95% CI 1.11-2.24, P=0.01), according to Anna Broder, MD, of Albert Einstein College of Medicine in New York City, and colleagues.
They also were more likely to have triglyceride levels above 150 mg/dL (OR 1.6, 95% CI 1.2-2.3, P=0.005), Broder reported at the annual meeting of the European League Against Rheumatism.
"More and more studies in recent years have reported a link between obesity and psoriatic arthritis. In addition, patients whose body mass index is high are less able to achieve or maintain low disease activity in psoriatic arthritis," she said.
The association between obesity and psoriatic is complex, but is related to the production of inflammatory cytokines such as interleukin 1 (IL1), IL6, and tumor necrosis factor (TNF) alpha.
These cytokines also cause dysregulation of lipid metabolism in obesity and type 2 diabetes, resulting in deactivation of lipoprotein lipase, increased production of fatty acids, increased triglycerides, and a shift from low- density lipoprotein (LDL) to very LDL.
This leads to a pro-atherogenic lipid profile with high triglycerides, decreased high-density lipoprotein (HDL), and high or normal LDL.
The lipid profile associated with rheumatoid arthritis (RA) is quite different, she noted, and varies according to the stage of disease.
In early and presymptomatic RA, triglycerides and total cholesterol are elevated and HDL is low, but with symptom onset, the levels of all measures of the conventional lipid profile decrease with a disproportionate decrease in HDL.
"Then, with treatment, an increase occurs in all lipid levels, and the implications of that for cardiovascular risk screening are the subject of a big debate," she said.
The relationship between lipid profiles and psoriatic arthritis has not been as well characterized as that for RA, however, so the researchers analyzed data from the prospective Consortium of Rheumatology Researchers of North America (CORRONA) registry.
CORRONA currently includes 4,500 patients with psoriatic arthritis. For inclusion in this study, patients had to have at least one visit when lipid values and disease activity were recorded.
This provided a study population of 725 patients and about 39% were considered to have medium to high disease activity.
The high disease activity group included more women (57% versus 46%, P=0.006) and smokers (12.7% versus 7.7%, P=0.029), had shorter disease duration (8.7 versus 11.2 years, P=0.001), and had higher erythrocyte sedimentation rate and C-reactive protein.
Patients with high disease activity also were more likely to be prescribed conventional disease-modifying anti-rheumatic drugs (63% versus 51%, P=0.002) and prednisone (13% versus 4.5%, P<0.001), but were less likely to be treated with TNF inhibitors (57% versus 66%, P=0.015).
Mean BMI in patients with high disease activity was 31.7 kg/m2 compared with 30.6 kg/m2 in those with low disease activity.
The presence of enthesitis or dactylitis showed a positive association with total cholesterol above 200 mg/dL, with an odds ratio of 1.6 (95% CI 1.1-2.5, P=0.02).
The researchers also performed a subgroup analysis that included 54 patients who had more than one lipid measurement while enrolled in CORRONA.
In that group, increased disease activity also was associated with lower HDL and higher triglycerides on a regression analysis after adjusting for the duration between visits.
These subgroup findings didn't reach statistical significance, but this may have related to underpowering, Broder said.
"We showed that higher disease activity in psoriatic arthritis is associated with elevated total cholesterol and triglycerides, and in a prospective subanalysis we found that disease activity was associated with high triglycerides and decreased HDL, a pattern that is similar to that observed in type 2 diabetes and metabolic syndrome and obesity, and quite different from what's seen in RA," she said.
"There may be common pathogenic mechanisms for obesity and psoriatic arthritis, and this should be studied further," she concluded.
Study limitations included possible selection bias, as lipid measurements are not required in CORRONA, and the potential for residual confounding with corticosteroids and triglycerides.
The authors reported no conflicts of interest.
Primary source: European League Against Rheumatism
Source reference:
Labitigan M, et al. "Moderate to high disease activity in psoriatic arthritis is associated with elevated total cholesterol and triglycerides" EULAR 2013; Abstract OP302.
Nancy Walsh
Staff Writer
Nancy Walsh has written for various medical publications in the United States and England, including Patient Care, The Practitioner, and the Journal of Respiratory Diseases. She also has contributed numerous essays to several books on history and culture, most recently to The Book of Firsts (Anchor Books, 2010).
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