A faster progression from psoriasis to psoriatic arthritis is linked to increased systolic dysfunction

Background Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic immune-mediated diseases that increase cardiovascular (CV) risk due to chronic inflammation and traditional CV factors like obesity, hypertension, and dyslipidaemia. While PsA develops in about 30% of PsO patients, some experience both conditions concurrently. Emerging evidence suggests that concurrent PsO and PsA may represent a more aggressive phenotype, with more severe systemic inflammation, potentially leading to greater CV complications. Objective Determine the association between current psoriasis and psoriatic arthritis and alterations in the left ventricle's geometry, diastolic, and systolic function. Methods We conducted a cross-sectional and comparative study that included PsA patients aged 35 to 75 years who met the 2006 CASPAR criteria. Patients with prior CV disease, pregnancy, and overlap syndrome were excluded. Patients were divided into two groups: those with concurrent PsO and PsA (transition time ≤1 year) and those who developed PsO before PsA (transition time >1 year). Echocardiographic measurements were made using B-mode, M-mode, Spectral Doppler, Colour Doppler, and Tissue Doppler Imaging; cardiac geometry, diastolic function, and systolic function were classified according to the 2016 ASE/EACVI criteria. The normality was assessed with the Kolmogorov-Smirnov test. Comparisons were performed using the Student's T-test, Chi-square test, and Mann-Whitney U test, accordingly. A p-value of ≤0.05 was considered statistically significant. Results A total of 78 patients with psoriasis (PsO) and psoriatic arthritis (PsA) were analyzed. The concurrent PsO-PsA group was younger (50.07 ± 11.28 vs. 54.89 ± 12.78 years; p = 0.066) and had a higher proportion of women (75.61% vs. 48.64%; p = 0.014). The median PsO-to-PsA transition time was shorter in this group (0 vs. 10.00 years; p < 0.001), with a shorter PsO duration (6.5 vs. 19.50 years; p = 0.006). Cardiovascular risk factors, including obesity, diabetes, hypertension, dyslipidemia, and smoking, were similar between groups. However, NSAID use was more frequent in the PsO-before-PsA group (70.27% vs. 41.46%; p = 0.011). Echocardiographic analysis showed no differences in ventricular geometry or left ventricular mass index (LVMI). Diastolic dysfunction was common in both groups, with Grade 2 being the most prevalent (80.48% vs. 70.27%; p = 0.294). Systolic function, assessed by GLS and LVEF, was comparable, but the concurrent group had significantly higher TAPSE (20.32 ± 6.24 vs. 23.09 ± 5.05; p = 0.035) and PSAP values (24.35 ± 7.00 vs. 18.99 ± 8.66 mmHg; p = 0.004). Conclusion This study reveals that patients with concurrent PsO and PsA exhibit altered cardiovascular characteristics compared to those with PsO preceding PsA, particularly in systolic function, with lower TAPSE and higher PSAP values.