Is the SCORE chart underestimating the real cardiovascular (CV) risk of patients with psoriatic arthritis? Prevalence of subclinical CV disease detected by carotid ultrasound.

Objectives: To analyse the cardiovascular risk according to the SCORE chart in a series of patients with psoriatic arthritis, and to study the presence of subclinical cardiovascular disease by carotid ultrasound.
Methods: Cross-sectional descriptive study of patients with psoriatic arthritis attended in a tertiary hospital. The presence of classical cardiovascular risk factors and the clinical characteristics of the patients were recorded. The cardiovascular risk was calculated with SCORE, calibrated for Spain. Common carotid ultrasound was conducted to assess intima-media thickness and the presence of atheroma plaques. Patients were reclassified upon ultrasound results. Statistical analyses were made for sample description, and multivariate analyses were performed to investigate the associations with the presence of atheroma plaques.
Results: A total of 102 patients were included. According to SCORE charts, 70.6% of the patients had intermediate cardiovascular risk, 25.5% high risk and 3.9% very high risk. After the ultrasound study, 26.5% of the patients were upgraded, and reclassified as very high risk due to the presence of plaques. The presence of subclinical vascular disease was associated with higher uric acid levels (P=0.036) and the presence of 2 or more cardiovascular risk factors (P=0.021).
Conclusions: A considerable number of psoriatic arthritis patients have a priori moderate or high risk of a fatal cardiovascular event. Carotid ultrasound detects subclinical vascular disease and increases the real risk in a substantial proportion of patients. Cardiovascular risk prediction clinical tools such as the SCORE underestimate the presence of subclinical cardiovascular disease in patients with psoriatic arthritis.
(Copyright © 2017 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.)