Abstract
Objective Since the addition of carotid ultrasound into composite cardiovascular risk (CVR) scores has been found effective for identifying patients with inflammatory arthritis and high CVR, we aimed to determine if its use would facilitate the reclassification of patients with psoriatic arthritis (PsA) into the very-high-risk SCORE (Systematic Coronary Risk Evaluation) category and whether this might be related to disease features.
Methods Cross-sectional study involving 206 patients who fulfilled CASPAR criteria for PsA and 197 controls. We assessed lipid profile, SCORE, disease activity measurements, and the presence of carotid plaques and carotid intima-media thickness by ultrasonography. A multivariable regression analysis, adjusted for classic CVR factors, was performed to evaluate if the risk of reclassification could be explained by disease-related features and to assess the most parsimonious combination of risk reclassification predictors.
Results Forty-seven percent of patients were reclassified into a very-high SCORE risk category after carotid ultrasound compared to 26% of controls (p=0.000). Patients included in the low-risk SCORE category were those who were more commonly reclassified (30% vs. 14%, p=0.002). The DAPSA score was associated with reclassification (beta coefficient 1.10 [95%CI 1.02-1.19], p=0.019) after adjusting for age and traditional CVR factors. A model containing SCORE plus age, statin use, and DAPSA score yielded the highest discriminatory accuracy compared to the SCORE alone model (AUC 0.863 [95%CI 0.789-0.936] vs. 0.716 [95%CI 0.668-0.764], p=0.000).
Conclusion PsA patients are more frequently reclassified into the very-high SCORE risk category following carotid ultrasound assessment than controls. This was independently explained by the disease activity.
