Active peripheral inflammation is associated with pro-atherogenic lipid profile in psoriatic arthritis

Objective The association between psoriatic arthritis (PsA) disease activity and lipid profiles has not been explored. We studied the association between active peripheral arthritis and/or enthesitis/daclylitis with lipid measurements in PsA. Methods We conducted a cross-sectional study of PsA patients enrolled in the Consortium of Rheumatology Researchers of North American (CORRONA) registry. Low activity was defined as Clinical Disease Activity Index (CDAI) ≤ 10 without enthesitis or dactylitis. Moderate-to-high peripheral disease activity was defined as CDAI > 10 and/or the presence of enthesitis/dactylitis. Results Of the 4672 patients with PsA enrolled in the CORRONA registry from June 2008 to October 2012, 725 (15.5%) had complete data on CDAI and lipid measurements. Of them, 284 (39%) patients had CDAI > 10 and/or enthesitis/dactylitis. Moderate-to-high group included more women and more current smokers. Patients with moderate-to-high disease activity had shorter duration of disease, and were more likely to be on prednisone, but less likely to use tumor necrosis factor (TNF) inhibitors. Moderate-to-high peripheral disease activity was associated with abnormal total cholesterol (TC) (>200 mg/dl), odds ratio (OR) = 1.58; 95% CI: (1.11, 2.24); p = 0.01, and abnormal triglycerides (TG) (>150 mg/dl), OR = 1.64; 95% CI: (1.16, 2.32); p = 0.005, after adjusting for gender, duration of PsA, smoking, body mass index, diabetes, modified Heath Assessment Questionnaire scores, as well as the following medications: methotrexate, other non-biologic disease modifying anti-rheumatic drugs, prednisone, TNF inhibitors, cholesterol lowering medications, and fish oil. The presence of enthesitis and/or dactylitis, irrespective of CDAI scores, was associated with abnormal TC, OR = 1.64; 95% CI: (1.08, 2.48); p = 0.02. Conclusion Our findings suggest an association between peripheral joint inflammation and lipid dysregulation in PsA. Further studies are needed to determine if treating PsA improves lipid profiles and cardiovascular mortality.