Ancuța Codrina MD, PhD
University of Medicine and Pharmacy “Grigore T. Popa” Iasi
Clinical Recovery Hospital, Rheumatology 2
Updates in the management of cardiovascular risk in psoriatic disease
Author: Ancuța Codrina
Psoriatic arthritis (PsA) remains a heterogeneous, multifaceted entity characterized by local (synovial, enteral, cutaneous) and systemic inflammation, accompanied by specific tissue damage, mainly destructive lesions and proliferative peripheral as well as axial lesions.
In fact, the concept of psoriatic disease extends beyond the burden of articular and skin disorder, assuming a wide spectrum of systemic features ranging from concept-related manifestation to various complications and co-morbidities such as cardiovascular disease (CV) , CV risk factors and metabolic syndrome, with prognostic and therapeutic implications.
High CV morbidity and, even, mortality rate directly linked to PsA activity and severity, high incidence of traditional factors (obesity, hypertension, diabetes, hyperlipidemia, metabolic syndrome) and CV events (coronary, cerebrovascular) including major events (infarction, stroke, CV death), along with an increased risk of subclinical coronary artery disease (surrogate markers – carotid intima-medium index, atheroma plaques) are also recognized in both PsA and psoriasis.
Moreover, the dynamic overlap between traditional CV factors, systemic inflammation, early accelerated atherosclerosis and rheumatic condition per se value the classic pathobiological model of CV damage in chronic immune inflammatory pathology.
The 2016 EULAR (European League Against Rheumatism) recommendations underline the main directions in assessing CV risk in immune-mediated rheumatic disorders, emphasizing optimal disease control (early diagnosis, treat-to-target strategy, dynamic use of synthetic and biological, TNF and non-TNF, drugs) as well as the role of non-pharmacological management of risk factors.
The burden of CV disease, optimal strategy for identifying and stratifying CV risk, selection of medication based on its cardiotoxicity potential are crucial for the management of CV risk in psoriatic disease.