The Link Between Psoriatic Arthritis and Heart Disease

Psoriatic arthritis (PsA) is a chronic autoimmune condition causing inflammation of the skin and joints. But the problem doesn't end there. Systemic inflammation throughout the body from psoriatic arthritis increases the risk of cardiovascular disease.

This article discusses PSA, its association with heart disease, and ways to lower risk.

What Is Psoriatic Arthritis?

PsA is a chronic inflammatory condition that affects the joints. It occurs in up to 1 in 3 people with psoriasis (a skin condition causing red, itchy, scaly patches).

Joint involvement in PsA can be severe and disabling, particularly when not identified and treated early. People with PsA may experience the following symptoms:

• Red, scaly, and itchy plaques on the skin
• Small indentations on the nails
• Swollen, stiff, and painful joints, especially in the hands
• Red, swollen fingers or toes, known as dactylitis
• Pain and swelling of the tendons

Psoriatic Arthritis and Heart Disease

PsA increases the risk of heart disease both directly and indirectly.

First, PsA inflammation is not just in the skin and joints. PsA causes systemic inflammation throughout the body, including in the blood vessels. Blood vessel inflammation contributes to the buildup of cholesterol plaques, or atherosclerosis, which causes heart attacks, ischemic strokes, and peripheral artery disease.

In addition to the direct effect of inflammation on blood vessels, PsA and other inflammatory diseases are linked with heart disease risk factors, like high blood pressure, high cholesterol, insulin resistance, and obesity. These, in turn, further increase the risk of cardiovascular disease.

Treatment

Since inflammation from PsA increases the risk of heart disease, controlling inflammation is an important goal of therapy.

Treating PsA includes taking anti-inflammatory medications, which can be given by mouth or injection. Some anti-inflammatory medications appear to decrease vascular inflammation and atherosclerosis in people with PsA.

Topical medications applied to the skin and phototherapy (light therapy) may also be added to alleviate skin symptoms.

Ways to Reduce the Risk of Heart Disease in PsA

Understand the Risk Factors

PsA and other inflammatory conditions are known risk factors for heart disease. When combined with other risk factors for heart disease, the risk is even higher.

The following are other risk factors that further increase heart disease risk:

• High cholesterol
• Insulin resistance and diabetes
  
• Obesity
• Smoking
• Sedentary lifestyle
  

Regular Screening Tests

Psoriatic arthritis is associated with several other heart disease risk factors, and the following tests can help screen for risks:

• Blood pressure screening
• Lipid panel to screen for high cholesterol
• Hemoglobin A1c or blood sugar test to screen for diabetes or insulin resistance
• Body mass index (BMI) to screen for clinical obesity
• Inflammatory markers, like C-reactive protein (CRP), to demonstrate levels of systemic inflammation
• Coronary calcium score, to be considered for those with borderline to intermediate cardiac risk to help decide if cholesterol-lowering medications are needed

Review Medication Choices with a Healthcare Provider

Rheumatologists (doctors who specialize in inflammatory disease) can help choose an individualized treatment plan for people with PsA based on the severity of symptoms and inflammation.

Medications for treating PsA include:

• Nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), especially for mild disease
• Disease-modifying anti-rheumatic drugs (DMARDS) which include Otrexup (methotrexate)
• Biologic medications, like TNF-inhibitors and interleukin inhibitors

Some anti-inflammatory medications for PsA appear to reduce vascular inflammation and atherosclerosis. For example, one study showed that those on TNF-alpha inhibitors had favorable effects in people with coronary atherosclerosis. More research is needed to determine the exact role for particular PsA therapies in reducing heart disease risk.

Another aspect to consider is that certain anti-inflammatory medications may increase blood pressure and blood sugar, and cause weight gain. Furthermore, some medications used to treat PsA may not be as effective in people with clinical obesity.

Lifestyle Changes

While the increased risk of heart disease with PsA is concerning, there are ways to decrease risk that apply to everyone, including:

• Eat a healthy diet. The Mediteranean diet has known benefits for heart health, and has some evidence for improving psoriasis symptoms.
• Exercise regularly.
• Quit smoking.
• Manage weight with a low-calorie diet, which has beneficial effects on heart health and PsA.
  
• Control cholesterol and blood sugar with diet, exercise, and medications, when necessary.
  

Summary

Psoriatic arthritis is a chronic autoimmune condition that can lead to significant joint pain and dysfunction. The inflammatory effects of PsA also increase heart disease risk.

Treating PsA is important to prevent joint complications and improve quality of life. It also appears to reduce the risk of heart disease. Management of PsA should include monitoring for heart disease risk and implementing preventive strategies like cholesterol medication and lifestyle changes.

A Word From Verywell

Dealing with a chronic condition like PsA that causes pain and affects daily life can be a struggle. It's important to work closely with a rheumatologist who can help keep skin and joint symptoms under control so you can maintain an active and healthy lifestyle. This will also help keep your heart as healthy as possible. As always, if you have any signs of heart disease, including chest discomfort or shortness of breath with exertion, you should not delay seeking medical attention.