The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Tai Po Hospital, Hong Kong.
Arthritis Rheumatol. 2019 Feb;71(2):271-280. doi: 10.1002/art.40695. Epub 2019 Jan 5.
To investigate the effects of achieving minimal disease activity (MDA) on the progression of subclinical atherosclerosis and arterial stiffness in patients with psoriatic arthritis (PsA).
A total of 101 consecutive patients with PsA were recruited for this prospective cohort study. All patients received protocolized treatment targeting MDA for a period of 2 years. High-resolution carotid ultrasound and arterial stiffness markers were assessed annually. The primary outcome measure was the effect of achieving MDA at 12 months (MDA group) on the progression of subclinical atherosclerosis over a period of 24 months. Secondary objectives were to compare the changes in arterial stiffness markers over 24 months between the MDA and non-MDA groups, as well as the changes in subclinical atherosclerosis and arterial stiffness markers in patients who achieved MDA at each visit from month 12 through month 24 (sustained MDA [sMDA]).
Ninety PsA patients (mean ± SD age 50 ± 11 years, 58% male [n = 52]) who completed 24 months of follow-up were included in this analysis. Fifty-seven patients (63%) had achieved MDA at 12 months. Subclinical atherosclerosis and arterial stiffness outcomes were similar between the MDA and non-MDA groups. Forty-one patients (46%) achieved sMDA. As shown by multivariate analysis, achieving sMDA had a protective effect on plaque progression (odds ratio 0.273 [95% confidence interval 0.088-0.846], P = 0.024), and less of an increase in total plaque area, mean intima-media thickness, and augmentation index values after adjustment for covariates.
Our results support the recommendation that once MDA is achieved, it should ideally be maintained for a prolonged period in order to prevent progression of carotid atherosclerosis and arterial stiffness in patients with PsA.
探讨达到疾病活动最小化（MDA）对银屑病关节炎（PsA）患者亚临床动脉粥样硬化和动脉僵硬度进展的影响。
本前瞻性队列研究共纳入 101 例连续的 PsA 患者。所有患者均接受针对 MDA 的方案化治疗，为期 2 年。每年评估高分辨率颈动脉超声和动脉僵硬度标志物。主要结局指标为 12 个月时达到 MDA（MDA 组）对 24 个月期间亚临床动脉粥样硬化进展的影响。次要目标是比较 MDA 组和非 MDA 组 24 个月期间动脉僵硬度标志物的变化，以及在 12 个月至 24 个月期间每次就诊时达到 MDA 的患者（持续 MDA [sMDA]）中亚临床动脉粥样硬化和动脉僵硬度标志物的变化。
本分析纳入了完成 24 个月随访的 90 例 PsA 患者（平均年龄 ± 标准差为 50 ± 11 岁，58%为男性[n=52]）。12 个月时 57 例（63%）达到 MDA。MDA 组和非 MDA 组的亚临床动脉粥样硬化和动脉僵硬度结局相似。41 例（46%）达到 sMDA。多变量分析显示，达到 sMDA 对斑块进展具有保护作用（比值比 0.273[95%置信区间 0.088-0.846]，P=0.024），并且在调整协变量后，总斑块面积、平均内膜中层厚度和增强指数值的增加较少。
我们的结果支持这样的建议，即一旦达到 MDA，理想情况下应维持较长时间，以防止 PsA 患者颈动脉粥样硬化和动脉僵硬度的进展。
