Psöriatik Artrit Alt Tiplerinde Metabolik Sendrom Sıklığı ve Kardiyovasküler Risk Faktörlerinin Değerlendirilmesi

Yıl 2022, , 5 - 12, 01.04.2022

Mürşide Esra Dölarslan , Hüseyin Ediz Dalkılıç , Saim Sag , Sümeyye Güllülü

https://doi.org/10.32708/uutfd.1024677

Öz

Psöriatik Artrit (PsA), aksiyel ve periferik eklemleri tutabilen kronik inflamatuvar hastalıktır. PsA’daki kronik inflamasyonun ateroskleroz ve periferik insülin direncine yol açtığı öne sürülmektedir. Bu çalışmanın amacı, PsA eklem tutulum tiplerine göre subklinik aterosklerozun göstergesi olan karotis intima media kalınlığı (KİMK) ile metabolik sendrom komponentleri arasındaki ilişkiyi araştırmaktadır. 74 PsA, 38 Romatoid Artrit (RA) ve 53 sağlıklı kişi çalışmaya dahil edildi. PsA’lı hastalar RA benzeri periferik eklem tutulumu ve spondiloartrit benzeri eklem tutulumu olmak üzere iki tipe ayrıldı. Hasta dosyalarından yaş, cinsiyet, laboratuvar verileri, tedavide kullanılan ilaçlar kayıt edildi. Hastaların bel çevresi ve kan basıncı ölçümleri yapıldı. Ultrasonografi ile KİMK’na bakıldı. RA hastaları PsA hastalarına göre ve her iki hasta grubu sağlıklı kontrol grubuna göre önemli ölçüde yüksek KİMK seviyelerine sahipti. (p<0,001). Metabolik sendrom sıklığı PsA’lı hastalarda RA’lı hastalardan daha yüksek idi (p=0,036). PsA subgrupları arasında KİMK, metabolik sendrom varlığı ve Framingham risk skoru açısından farklılık saptanmadı. KİMK’nın yaş, sedimentasyon, C-reaktif protein, açlık kan şekeri, total kolesterol, LDL-kolesterol, trigliserid, ürik asit düzeyleri, vücut kitle indeksi, sistolik ve diyastolik kan basıncı, sigara tüketimi ve Fragminham risk skoru ile pozitif korelasyonu mevcuttu. Çoklu lineer regresyon analizinde yaş ve Fragminham risk skoru KİMK’nda belirleyici olarak saptandı. PsA’lı hastalarda kardiyovasküler risklerin ve metabolik sendromun daha sık görüldüğü, fakat PsA alt gruplarında ateroskleroz açısından bir fark olmadığı tespit edildi.

Anahtar Kelimeler

Ateroskleroz, karotis intima media kalınlığı, metabolik sendrom, psöriatik artrit

Teşekkür

Çalışmaya katılan tüm bireylere teşekkür ederim

Metabolic Syndrome Frequency and Cardiovascular Risk Factors Assessment in Subtypes of Psoriatic Arthritis

Öz

Psoriatic arthritis (PsA) is a chronic inflammatory disease that can involve axial and peripheral joints. It is known that chronic inflammation in PsA plays a role in atherogenesis and peripheric insulin resistance. The aim of this study is to determine the relationship between carotid intima- media thickness (CIMT), which is an indicator of subclinical atherosclerosis, and metabolic syndrome components in patients with PsA according to joint involvement types. In our study, we included 74 PsA, 38 rheumatoid arthritis (RA) patients and 53 healthy people. Patients with PsA was divided into two types as peripheral and axial joint involvement. Age, gender, laboratory values, drugs were obtained from hospital files and waist circle, blood pressure, CIMT were measured in all subject. RA patients had significantly higher CIMT levels than PsA patients and both patient groups compared to the healty control group. (p<0.001). The frequency of metabolic syndrome was higher in patients with PsA than in patients with RA (p=0.036). No difference was found between PsA subtypes in terms of CIMT, presence of metabolic syndrome and Framingham risk score. There was a positive correlation of CIMT with age, sedimentation, CRP, fasting blood glucose, total cholesterol, LDL- cholesterol, triglyceride, uric acid levels, body mass index, systolic/diastolic blood pressure, smoking consumption and Framingham risk score. Multiple linear regression analysis revealed that age and Framingham risk score were the independent predictors of CIMT.In our study, cardiovascular risks and metabolic syndrome were showed often in PsA patients, but there was no difference in subtypes of PsA for atherosclerosis.

Anahtar Kelimeler

Atherosclerosis, carotid intima media thickness, metabolic syndrome, psoriatic arthritis

Kaynakça

• 1- Wright V, Moll JM. Psoriatic arthritis. In: Wright V, Moll JM (Eds.). Seronegative polyarthritis. Amsterdam: North Holland Publishing CO, 1976, :169-235
• 2- Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM. Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol 2006;55(5): 829-835. Doi: 10.1016/j.jaad.2006.08.040
• 3- Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 2001; 285(19): 2486-2497. Doi: 10.1001/jama.285.19.2486
• 4- Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation, 1986; 74(6):1399-1406. Doi: 10.1161/01.cir.74.6.1399
• 5- Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med, 1987; 316(22):1371-1375. Doi: 10.1056/NEJM198705283162204
• 6- De Vla K, Gottlieb AB and Mease PJ. Current Concepts in Psoriatic Arthritis: Pathogenesis and Management. Acta Derm Venereol. 2014; 94: 627–634.
• 7- Kozan O, Oguz A, Abaci, et al. Prevalence of the metabolic syndrome among Turkish adults. Eur J Clin Nutr, 2007;61(4):548-553. Doi: 10.1038/sj.ejcn.1602554
• 8- Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA. Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol, 2002; 156(11): 1070-1077. Doi: 10.1093/aje/kwf145
• 9- Arslan M, Atmaca A, Ayvaz G, ve ark. Türkiye Endokrinoloji ve Metabolizma Derneği Metabolik Sendrom Kılavuzu. Ankara, Bayt bilimsel araştırmalar basın yayın ve tanıtım Ltd. Şti, 2009. 7-13
• 10- Ross R. Atherosclerosis; an inflammatory disease. N Engl J Med. 1999; 340(2):115-126. Doi: 10.1056/NEJM199901143400207
• 11- Kinlay S, Ganz P. Role of endothelial dysfunction in coronary artery disease and implications for therapy. Am J Cardiol, 1997;80(9A):11I–16I. Doi: 10.1016/s0002-9149(97)00793-5
• 12- Ross R, Glomset JA. The pathogenesis of atherosclerosis (first of two parts), N Engl J Med 1976; 295(7):369–377. Doi: 10.1056/NEJM197608122950707
• 13- Hodis HN, Mack WJ, LaBree L, et al. The role of carotid arterial intima media thickness in predicting clinical coronary events. Ann Intern Med 1998; 128(4):262-269. Doi: 10.7326/0003-4819-128-4-199802150-00002
• 14- Man Lam SH, Cheng IT, Li EK, et al. DAPSA, carotid plaque and cardiovascular events in psoriatic arthritis: a longitudinal study. Ann Rheum Dis, 2020;79(10):1320-1326. Doi: 10.1136/annrheumdis-2020-217595
• 15- Kimhi O, Caspi D, Bornstein NM, et al. Prevalence and risk factors of atherosclerosis in patients with psoriatic arthritis. Semin Arthritis Rheum,2007;36(4):203-209. Doi: 10.1016/j.semarthrit.2006.09.001
• 16- Kerschbaumer A, Fenzl KH, Erlacher L and Aletaha d. An overview of psoriatic arthritis – epidemiology, clinical features, pathophysiology and novel treatment targets. Wien Klin Wochenschr. 2016;128:791–795. Doi: 10.1007/s00508-016-1111-9
• 17- Peluso R, Lervolino S, Vitiello M, Bruner V, Lupoli G and Di Minno MND. Extra-articular manifestations in psoriatic arthritis patients. Clin Rheumatol. 2015;34(4):745-753. Doi: 10.1007/s10067-014-2652-9.
• 18- FitzGerald O, Haroon M, Giles JT and Winchester R. Concepts of pathogenesis in psoriatic arthritis: genotype determines clinical phenotype. Arthritis Research & Therapy. 2015; 17:115. Doi: 10.1186/s13075-015-0640-3
• 19- Gonzalez-Juanatey C, Llorca J, Amigo-Diaz E, Dierssen T, Martin J, Gonzalez-Gay MA. High prevalence of subclinical atherosclerosis in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis & Rheumatism, 2007;57(6):1074-1080. Doi: 10.1002/art.22884
• 20- Lin YC, Dalal D, Churton S, et al. Relationship between metabolic syndrome and carotid intima-media thickness: cross-sectional comparison between psoriasis and psoriatic arthritis. Arthritis Care Res (Hoboken), 2014;66(1):97-103. Doi: 10.1002/acr.22144
• 21- Tam LS, Li EK, Shang Q, et al. Tumour necrosis factor alpha blockade is associated with sustained regression of carotid intima-media thickness for patients with active psoriatic arthritis: a 2-year pilot study. Ann Rheum Dis.2011;70(4):705-706. Doi: 10.1136/ard.2010.131359
• 22- Angel K, Provan SA, Fagerhol MK, Mowinckel P, Kvien TK, Atar D. Effect of 1-year anti-TNF-α therapy on aortic stiffness, carotid atherosclerosis, and calprotectin in inflammatory arthropathies: a controlled study. Am J Hypertens, 2012;25(6):644-650. Doi: 10.1038/ajh.2012.12
• 23- Ramonda R, Puato M, Punzi L, et al. Atherosclerosis progression in psoriatic arthritis patients despite the treatment with tumor necrosis factor-alpha blockers: a two-year prospective observational study. Joint Bone Spine. 2014; 81(5): 421-425. Doi: 10.1016/j.jbspin.2014.02.005
• 24- McCarey DW, Mclnnes IB, Madhok R, et al. Trial of Atorvastatin in Rheumatoid Arthritis (TARA): double blind, randomised placebo controlled trial. Lancet 2004;363(9426):2015–2021. Doi: 10.1016/S0140-6736(04)16449-0
• 25- Cheng IT, Wong KT, Li EK, et al. Comparison of carotid artery ultrasound and Framingham risk score for discriminating coronary artery disease in patients with psoriatic arthritis. RMD Open. 2020;6:e001364. Doi:10.1136/rmdopen-2020-001364
• 26- Eder L, Chandran V and Gladman DD. The Framingham Risk Score underestimates the extent of subclinical atherosclerosis in patients with psoriatic disease. Ann Rheum Dis. 2013;0:1–7. Doi:10.1136/annrheumdis-2013-203433