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Psoriatic Arthritis and Metabolic Syndrome

People living with PsA should be assessed for metabolic syndrome, given the elevated risk for heart disease and other effects.

Patients with psoriatic arthritis (PsA) are at higher risk of having metabolic syndrome than those with psoriasis alone or rheumatoid arthritis, according to a systematic review and meta-analysis published online in the International Journal of Rheumatic Diseases. [1] Given the association of metabolic syndrome with elevated cardiovascular risk, this should be something that providers assess, the authors of the study wrote.

Metabolic syndrome consists of a group of conditions that put individuals at higher risk for heart disease and diabetes. It includes high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. [2] Metabolic syndrome has been associated with systemic inflammation, and in patients with PsA, these conditions have been further linked to difficulty in attaining minimal disease activity. According to the Journal of Rheumatology, “A state of minimal disease activity has been established and is defined by low activity assessed by tender/swollen joint counts, tender entheseal points [the places where tendons and ligaments attach to the bone], Psoriasis Area and Severity Index or body surface area, patient pain and global activity visual analog scale, and functional evaluation by Health Assessment Questionnaire.” [3]

More than 10% of patients newly diagnosed with PsA develop heart disease within 10 years of developing new-onset inflammatory arthritis, the authors wrote. Patients with PsA also are more likely to die from heart disease.

In their systematic review, the researchers examined cross-sectional studies, randomized controlled trials, cohort studies, and case-control studies published between January 1990 and August 19, 2019, found in peer reviewed literature databases: MEDLINE, PubMed, EMBASE, Google Scholar, ProQuest, Ebsco CINAHL, Scopus, Science Direct, Web of Science, and the Cochrane Library. They excluded studies with 20 or fewer patients. After screening, the final analysis included 24 studies in patients with PsA, 89 in patients with psoriasis and 53 in patients with rheumatoid arthritis.

Researchers found that patients with PsA were nearly twice as likely to have metabolic syndrome when compared with patients with psoriasis alone (1.61) and rheumatoid arthritis (1.66). However, the researchers had difficulty determining how many patients with psoriasis also had PsA, which was a limitation of this study.

The researchers also collected data on the presence of individual components of metabolic syndrome in each patient group: central obesity, high triglycerides, low high-density lipoproteins (HDL), and diabetes. While they found the presence of each of these components to be similar across groups, the significantly higher rate of metabolic syndrome in patients with PsA suggests that these patients may be at higher risk of experiencing more than one of these heart disease risk factors compared with patients with rheumatoid arthritis or psoriasis alone.

“MetS [metabolic syndrome] is often not evaluated by rheumatologists as part of routine assessments in patients with inflammatory arthritis,” the authors wrote. However, various metabolic risk factors increase the risk of heart disease symptoms and death in patients and the systemic inflammation resulting in these comorbidities may also affect the efficacy of disease-modifying therapy, thus perhaps preventing patients from achieving a state of minimal disease activity.

Metabolic syndrome is just one of the comorbidities associated with psoriatic disease. Others include cardiovascular disease and mental health conditions. If you would like to learn more about comorbidities associated with psoriatic disease, please visit the NPF Live All the Days of Your Life page.

If you experience symptoms of or are living with PsA, you should speak with your health care provider or rheumatologist about assessing your metabolic syndrome risk and managing metabolic syndrome, should it develop.

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To learn more about metabolic syndrome and managing life with PsA and comorbidities, contact an NPF Patient Navigator.

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Article References

References

1. Loganathan A, Kamalaraj N, El-Haddad C, Pile K. Systematic review and meta-analysis on prevalence of metabolic syndrome in PsA, rheumatoid arthritis and psoriasis. Int J Rheum Dis. Published online June 2, 2021. doi:10.1111/1756-185X.14147

2. Metabolic syndrome. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916. Accessed June 2021.

3. Gossec L, McGonagle D, Korotaeva T, Lubrano E, et al. The Journal of Rheumatology. January 2018. DOI: https://doi.org/10.3899/jrheum.170449

Author

Heather Onorati

Title

Freelance writer

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