Department of Clinical and Experimental Medicine, Reference Centre for Coagulation Disorders, Federico II University, Naples, Italy.
J Rheumatol. 2012 Feb;39(2):334-6. doi: 10.3899/jrheum.110741. Epub 2011 Dec 15.
Platelet aggregation plays a major role in vascular mortality. Individuals with psoriatic arthritis (PsA) are highly predisposed to vascular mortality. We evaluated the correlation between disease activity and platelet aggregation in individuals with PsA.
Individuals with PsA receiving tumor necrosis factor-α (TNF-α) blockers (n = 114) and healthy controls (n = 114) matched for age, sex, and cardiovascular risk factors were tested for light transmission aggregometry. None was receiving antiinflammatory drugs. Platelet aggregation (max-A%) was defined as maximal light transmittance achieved within 5 min after the addition of 0.1 or 0.2 mM arachidonic acid or 0.4 μM adenosine diphosphate. A value of ≥ 50% irreversible light transmittance (LT-50%) following platelet stimulation was used to define platelet hyperreactivity. Minimal disease activity (MDA) was evaluated in subjects with PsA.
Regardless of the agent used, individuals with PsA showed a higher max-A% and achieved LT-50% more often than controls. Among individuals with PsA, those achieving MDA exhibited a max-A% similar to that of controls, both being significantly lower (p < 0.001) than max-A% of subjects with active disease. Subjects with active disease showed platelet hyperreactivity (LT-50%) more often than those achieving MDA (p < 0.001). For increasing quartiles of max-A%, C-reactive protein levels increased and prevalence of MDA decreased.
Compared with those achieving MDA, subjects with active PsA disease had abnormally high platelet reactivity. Whether this is relevant for the cardiovascular risk profile of subjects with PsA receiving TNF-α blockers requires further evaluation.
血小板聚集在血管死亡率中起着重要作用。患有银屑病关节炎（PsA）的个体极易发生血管死亡率。我们评估了 PsA 个体的疾病活动与血小板聚集之间的相关性。
接受肿瘤坏死因子-α（TNF-α）阻滞剂治疗的 PsA 个体（n = 114）和年龄、性别和心血管危险因素相匹配的健康对照者（n = 114）接受了光传输聚集测定。均未接受抗炎药物治疗。血小板聚集（最大 A%）定义为在加入 0.1 或 0.2 mM 花生四烯酸或 0.4 μM 二磷酸腺苷后 5 分钟内达到的最大光透过率。使用≥50%不可逆光透射（LT-50%）来定义血小板高反应性，即在血小板刺激后。在 PsA 个体中评估最小疾病活动（MDA）。
无论使用何种药物，患有 PsA 的个体的最大 A%较高，达到 LT-50%的频率也高于对照组。在患有 PsA 的个体中，达到 MDA 的个体的最大 A%与对照组相似，均明显低于（p <0.001）处于疾病活动期的个体的最大 A%。处于疾病活动期的个体比达到 MDA 的个体更常出现血小板高反应性（LT-50%）（p <0.001）。随着最大 A%四分位数的增加，C 反应蛋白水平升高，MDA 的患病率降低。
与达到 MDA 的个体相比，处于疾病活动期的 PsA 个体的血小板反应性异常升高。对于接受 TNF-α 阻滞剂治疗的 PsA 个体的心血管风险状况是否相关，还需要进一步评估。
