psoriatic arthritis (PsA) is a chronic autoimmune disease that causes inflammation of the skin and joints. But the problem doesn’t stop there.Systemic inflammation from psoriatic arthritis increases risk of psoriasis Cardiovascular diseases.
This article discusses PSA, its relationship to heart disease, and ways to reduce your risk.
What is psoriatic arthritis?
PsA is a chronic inflammatory disease that affects the joints. It occurs in up to one-third of people with psoriasis (a skin condition that causes red, itchy, scaly patches).
Joint involvement in PsA can be severe and disabling, especially if not detected and treated early. People with PsA may experience the following symptoms:
- red, scaly and itchy patches on the skin
- Small dents on the nails
- Swelling, stiffness, and pain in the joints, especially in the hands
- red, swollen fingers or toes called toe inflammation
- tendon pain and swelling
Taking care of symptoms of PsA
Psoriatic Arthritis and Heart Disease
PsA directly or indirectly increases the risk of heart disease.
First, PsA inflammation isn’t just in the skin and joints. PsA causes systemic inflammation, including vascular inflammation.Inflammation of blood vessels contributes to the buildup of cholesterol plaque, or atherosclerosiswhich can lead to heart attack, ischemic stroke, and peripheral arterial disease.
In addition to the direct effects of inflammation on blood vessels, PsA and other inflammatory diseases are also associated with heart disease risk factors such as high blood pressure, high cholesterol, insulin resistance and obesity. These in turn further increase the risk of cardiovascular disease.
A large 16-year study showed that people with untreated PsA had a 36% higher risk of heart attack and stroke.
Because inflammation caused by PsA increases the risk of heart disease, controlling inflammation is an important goal of treatment.
Treatment of PsA involves taking anti-inflammatory drugs, which can be given by mouth or by injection. Some anti-inflammatory drugs appear to reduce vascular inflammation and atherosclerosis in patients with PsA.
Topical medicines are applied to the skin and Phototherapy (Phototherapy) can also be used to relieve skin symptoms.
Current American Heart Association and American College of Cardiology cholesterol guidelines recommend considering inflammatory diseases such as PsA as risk enhancers for lowering the threshold for starting statins (cholesterol drugs).
For people whose heart disease risk makes them borderline candidates for statins, a screening test called a coronary artery calcium score may be considered. This non-invasive test involves scanning pictures of the heart with CT (computed tomography) to look for calcium deposits in the coronary arteries.
Ways to Lower Your Risk of Heart Disease with PSA
Learn about risk factors
PsA and other inflammatory diseases are known risk factors for heart disease. The risk is even higher when combined with other risk factors for heart disease.
Here are other risk factors that further increase the risk of heart disease:
- high cholesterol
- Insulin resistance and diabetes
- sedentary lifestyle
regular screening tests
Psoriatic arthritis is associated with several other heart disease risk factors, and the following tests can help screen for risk:
- blood pressure screening
- Lipid panel for screening for high cholesterol
- Hemoglobin A1c or blood sugar test to screen for diabetes or insulin resistance
- Body Mass Index (BMI) for Screening for Clinical Obesity
- Inflammatory markers, such as C-reactive protein (CRP), to show levels of systemic inflammation
- Coronary artery calcium score, considered for people with borderline to intermediate cardiac risk, to help determine the need for cholesterol-lowering drugs
Review medication options with your healthcare provider
rheumatologist (Physicians who specialize in inflammatory diseases) can help choose a personalized treatment plan for people with PsA based on the severity of symptoms and inflammation.
Medications to treat PsA include:
- NSAIDs (such as ibuprofen and naproxen), especially for mild disease
- Disease-modifying antirheumatic drugs (DMARDS), including Otrexup (methotrexate)
- Biopharmaceuticals such as TNF inhibitors and interleukin inhibitor
Some anti-inflammatory drugs targeting PsA appear to reduce vascular inflammation and atherosclerosis. For example, one study showed that people taking TNF-alpha inhibitors had good outcomes in patients with coronary atherosclerosis. More research is needed to determine the exact role of specific PsA therapies in reducing heart disease risk.
Another aspect to consider is that certain anti-inflammatory drugs may increase blood pressure and blood sugar, and cause weight gain. In addition, some drugs used to treat PsA may not be effective in clinically obese patients.
While PsA increases the risk of heart disease, there are ways to reduce the risk that apply to everyone, including:
- Eat a healthy diet. The Mediterranean diet is good for heart health and has some evidence of improving psoriasis symptoms.
- Exercise regularly.
- Quit smoking.
- Weight control with a low-calorie diet for heart health and PsA benefits.
- Control cholesterol and blood sugar through diet, exercise, and medication as necessary.
Psoriatic arthritis is a chronic autoimmune disease that can cause severe joint pain and dysfunction. The inflammatory effects of PsA also increase the risk of heart disease.
Treating PsA is important for preventing joint complications and improving quality of life. It also appears to reduce the risk of heart disease. Management of PsA should include monitoring heart disease risk and implementing preventive strategies, such as cholesterol medications and lifestyle changes.
Dealing with a chronic condition like PsA that can cause pain and interfere with everyday life can be a daunting task. It’s important to work closely with a rheumatologist who can help manage skin and joint symptoms so you can maintain an active and healthy lifestyle. This will also help keep your heart as healthy as possible. As always, you should not delay seeking medical attention if you have any signs of heart disease, including chest discomfort or shortness of breath with exertion.
Frequently Asked Questions
Can Treating Psoriatic Arthritis Reduce Heart Disease?
People with more severe psoriatic arthritis have higher levels of inflammation that lead to a higher risk of heart disease. Research suggests that treating psoriasis with certain anti-inflammatory drugs may reduce blood vessel inflammation and atherosclerosis.
Does Psoriatic Arthritis Affect Arteries?
Inflammation in psoriatic arthritis is systemic, which means it has effects throughout the body. Studies have demonstrated several findings in patients with psoriatic arthritis, including increased carotid artery thickness, vessel wall dysfunction, and inflammation within the vessel wall.