Psoriatic arthritis belongs to a family of conditions called psoriatic disease, which also includes psoriasis, a chronic skin condition. Both involve an overactive immune system that causes widespread inflammation.
“This inflammation doesn’t just affect the joints or skin,” says Michael Garshick, MD, a cardio-rheumatologist at NYU Langone Health in New York City. A lot of the same immune cells and pro-inflammatory proteins that are upregulated in psoriatic disease are also involved in the development of atherosclerosis,” he says.
“In general, psoriasis and PsA are put together when we discuss heart disease risk. That’s mostly because there are many more patients with psoriasis compared to psoriatic arthritis, and the studies on heart disease and PsA haven’t been as robust,” says Dr. Garshick. It’s estimated that about 1 in 4 people with psoriasis also have PsA.
In general, people with psoriatic disease have a cardiovascular risk similar to those with moderate to severe psoriasis, says Garshick. “So if you have really only mild psoriasis, but you have psoriatic arthritis, that upgrades the risk of a higher risk of cardiovascular disease than if you didn’t have psoriatic arthritis,” he says.
Whether it’s psoriasis or psoriatic arthritis, it’s believed the combination of inflammation caused by the conditions and the fact that most patients with psoriatic disease have a higher risk of the traditional cardiometabolic risk factors — like hypertension, hyperlipidemia (high cholesterol), type 2 diabetes, obesity, and smoking — promotes cardiovascular disease, says Garshick.
PsA Inflammation Impacts Heart
Experts believe that heart disease and psoriasis and PsA may share inflammatory pathways that drive the progression of both diseases.
“Although psoriasis plaques are different from plaques in the arteries, the inflammation that makes the skin red and flaky is similar to the kind of inflammation that causes blockages in the arteries,” says Joel Gelfand, MD, the director of the psoriasis and phototherapy treatment center at Penn Medicine in Philadelphia.
In fact, a lot of the same immune cells and pro-inflammatory cytokines that are upregulated in psoriasis or psoriatic disease are also part of the disease process in atherosclerosis, specifically cytokines or proteins such as TNF-alpha, says Garshick.
Atherosclerosis is the buildup of fats and cholesterol in and on the artery walls, called plaque. The buildup limits blood flow and can eventually lead to heart attack or stroke.
There’s a really big overlap between the disease processes driving psoriasis and atherosclerosis, says Garshick. “There’s even evidence from genetic studies suggesting that in patients who have atherosclerosis, that may promote worsening psoriatic disease, so we think it’s a bidirectional relationship,” he says.
Higher Risk of Traditional Heart Disease Risk Factors
People with PsA are more likely to also have traditional heart disease risk factors, including high blood pressure, type 2 diabetes, obesity, and smoking.
“It’s really a synergy,” says Dr. Garshick. “It’s the combination of systemic inflammation and the higher rates of these common risk factors that increases the overall cardiovascular risk.”
Indeed, the PsA inflammation could contribute to or worsen cardiovascular disease risk factors, including the following:
- Insulin Resistance Inflammatory chemicals interfere with how the body uses insulin, leading to higher blood sugar and an increased risk of type 2 diabetes, a major heart disease risk factor.
- High Cholesterol Inflammation disrupts normal fat metabolism, raising triglycerides and lowering “good” HDL cholesterol, contributing to clogged arteries.
- Hormone Imbalance From Fat Tissue (Adipokines) The hormones leptin and resistin are elevated in PsA and promote more inflammation and artery damage.
“In general, the higher prevalence of atherosclerosis in the psoriatic patient population is a contribution from both underlying systemic inflammation and traditional cardiovascular risk factors,” says Garshick.
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