Psoriatic arthritis (PsA) is an inflammatory form of arthritis that can affect the skin and joints. An increasing body of research links the condition to heart disease.

PsA is an autoimmune disease, meaning that it occurs when the immune system mistakenly launches an attack on the body. This attack can trigger inflammation and pain.

There is a known link between PsA and heart health, with research showing that PsA increases the risk of cardiovascular conditions. It is likely that specific symptoms of PsA and the increased likelihood of other risk factors play a role.

In this article, we explain the connection between PsA and heart disease. We also cover what the latest research says and suggest strategies to reduce the risk of cardiovascular disease when living with PsA.

Most of the existing research exploring the link between heart disease and rheumatological diseases has focused on rheumatoid arthritis. Recently, however, there has been a growing body of research that links PsA and cardiovascular disease.

In a 2016 meta-analysis, researchers examined data from 11 studies involving more than 30,000 people with PsA. They found that people with PsA had a 43% higher risk of cardiovascular disease than those without PsA. This finding suggests that PsA is an independent risk factor in the development of cardiovascular disease.

The role of inflammation

Research also suggests that specific symptoms of PsA, such as inflammation in the sacroiliac joints in the back, can increase a person’s chance of a cardiovascular event.

A 2014 study identified an association between inflammation in the sacroiliac joints and increased aortitis. Aortitis is the term for inflammation of the aorta and is a known predecessor of cardiovascular disease.

PsA and most forms of heart disease are inflammatory conditions. When the immune system launches an inflammatory response, it affects systems all over the body, including the joints, skin, and heart.

Chronic inflammation is a known risk factor for heart disease and can also cause damage to blood vessels.

Other risk factors

People with PsA are also more likely to have traditional risk factors for heart disease, such as diabetes or obesity.

In a 2019 study, researchers found that those with PsA were more likely to have the following:

  • type 2 diabetes
  • hypertension
  • hyperlipidemia (high levels of fat in the blood)
  • obesity

These are all risk factors for heart disease.

In another study, researchers found that 24–58% of those with PsA had metabolic syndrome. Metabolic syndrome is an umbrella term for a group of conditions that increase the risk of heart disease.

People with severe PsA were more likely to have metabolic syndrome.

People with PsA can take steps to reduce their risk of cardiovascular disease and related complications.

Understanding the risk factors

It is important for individuals with PsA to be aware of whether they are already at higher risk of cardiovascular disease due to other factors, which include having any of the following:

  • high blood pressure
  • high cholesterol
  • type 2 diabetes
  • a history of smoking
  • a sedentary lifestyle
  • excess body weight

In 2019, the American College of Cardiology and the American Heart Association released new guidelines for preventing heart disease. The guidelines include psoriasis and other rheumatic inflammatory diseases as risk enhancers for heart disease and advise that risk-enhancing factors such as PsA should guide preventive interventions.

Those with PsA may benefit from regular screening for heart disease risk factors, including blood pressure, cholesterol, and excess body weight.

A doctor can offer advice about steps a person can take to help improve their heart health.

Reviewing medications with a doctor

Some medications for PsA may reduce the risk of heart disease, while others may increase it.

For example, steroids can raise cholesterol levels and cause the body to become less sensitive to insulin. In turn, this can contribute to the risk of cardiovascular disease.

Conversely, biologics and disease-modifying antirheumatic drugs (DMARDs) can not only ease joint pain but also protect the heart because they lower inflammation.

Making lifestyle adjustments

Making changes to dietary patterns and certain daily habits, if needed, may help reduce PsA symptoms and improve heart health. These changes may include the following:

  • Diet: Eating a diet rich in fruits and vegetables, whole grains, and fish but low in red meat and sugar can help minimize inflammation. Fatty fish, such as salmon and mackerel, contain anti-inflammatory fatty acids.
  • Losing excess weight: Excess weight can increase the risk of PsA and heart disease. Losing excess weight can help with symptoms of PsA, such as joint tenderness, and lower the risk of heart disease.
  • Medications: A doctor can prescribe medications to manage cholesterol, blood pressure, and blood sugar levels. This may be useful for some people living with PsA.
  • Not smoking: Quitting smoking, if applicable, will lower a person’s risk of heart disease and promote better overall health.

PsA is a chronic condition with known links to cardiovascular disease. Research suggests that PsA is an independent risk factor in developing heart disease. People with PsA are also more likely to have other risk factors for heart disease, such as metabolic syndrome.

However, these individuals can take several steps to reduce their risk of cardiovascular disease and associated complications. These include being aware of risk factors, undergoing regular screenings, and making lifestyle changes if needed. A doctor can offer advice on whether any medications might also be helpful.

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