Psoriasis and Psoriatic Arthritis Cardiovascular Disease Endotypes Identified by Red Blood Cell Distribution Width and Mean Platelet Volume

Abstract

In a subset of psoriasis (PsO) and psoriatic arthritis (PsA) patients, the skin and/or joint lesions appear to generate biologically significant systemic inflammation. Red cell distribution width (RDW) and mean platelet volume (MPV) are readily available clinical tests that reflect responses of the bone marrow and/or plasma thrombogenicity (e.g., inflammation), and can be markers for major adverse cardiac events (MACE). We aimed to evaluate if RDW and MPV may be employed as inexpensive, routinely obtained biomarkers in predicting myocardial infarction (MI), atrial fibrillation (AF), and chronic heart failure (CHF) in psoriatic and psoriatic arthritis patients. The study was divided into two parts: (a) case control study employing big data (Explorys) to assess MPV and RDW in psoriasis, psoriatic arthritis and control cohorts; (b) a clinical observational study to validate the predictive value of RDW and to evaluate RDW response to anti-psoriatic therapies. We used Explorys, an aggregate electronic database, to identify psoriatic patients with available MPV and RDW data and compared them to gender and age matched controls. The incidence of myocardial infarction (MI), atrial fibrillation (AF), and chronic heart failure (CHF) was highest among patients with both elevated RDW and MPV, followed by patients with high RDW and normal MPV. RDW elevation among PsA patients was associated with an increased risk of MI, AF, and CHF. In a local clinical cohort, high RDWs were concentrated in a subset of patients who also had elevated circulating resistin levels. Among a small subset of participants who were treated with various systemic and biologic therapies, and observed over a year, and in whom RDW was elevated at baseline, a sustained response to therapy was associated with a decrease in RDW. RDW and MPV, tests commonly contained within routine complete blood count (CBC), may be a cost-effective manner to identify PsO and PsA patients at increased risk of MACE.

Methotrexate Decreases the Level of PCSK9—A Novel Indicator of the Risk of Proatherogenic Lipid Profile in Psoriasis. The Preliminary Data

“…This disease was considered as a solely dermatological condition, while recent studies have linked psoriasis to many comorbidities namely obesity, cardiometabolic events, diabetes mellitus type 2 (DM type 2), lipid disturbances, and liver dysfunctions [1][2][3]. Further investigations have highlighted a higher risk of hypertension, metabolic syndrome (MS), or DM in association with the severity of psoriasis [1][2][3][4][5][6]. The morbidity of psoriatic patients is significantly higher compared with the population, which is due to the increased risk of cardiovascular events, mainly myocardial infarction (MI) and thromboembolic disorders [4][5][6][7].…”

“…Further investigations have highlighted a higher risk of hypertension, metabolic syndrome (MS), or DM in association with the severity of psoriasis [1][2][3][4][5][6]. The morbidity of psoriatic patients is significantly higher compared with the population, which is due to the increased risk of cardiovascular events, mainly myocardial infarction (MI) and thromboembolic disorders [4][5][6][7]. However, the exact etiology of atherothrombotic events in psoriasis is still unknown.…”

“…However, the exact etiology of atherothrombotic events in psoriasis is still unknown. Common mechanisms which are taken into consideration are chronic inflammation, genetics, insulin resistance (IR), angiogenesis, oxidative stress, numerous bioactive molecules or proatherogenic lipids, and lipoprotein propensity [5][6][7][8]. The putative connection between CMDs and psoriasis have been also translated through psoriatic march, which means that psoriasis augments inflammation causing endothelial dysfunction and finally to atherosclerosis and further to cardiovascular events [9].…”

Clinical significance of red blood cell distribution width in systemic lupus erythematosus patients

“…Therefore, inflammatory parameters, such as CRP and ESR, actually useful to assess and follow up the activity of autoimmune diseases; a novel index for inflammation, RDW, may be also useful to assess the activity of autoimmune diseases. Previous studies have shown that RDW was associated with the increased severity of inflammatory bowel disease (IBD), SLE [9,10], RA [11], and psoriatic arthritis [12,13]. Another recent study has also concluded that RDW was increased in patients with SLE [14].…”

<p>Cyclodextrin-Modified CeO₂ Nanoparticles as a Multifunctional Nanozyme for Combinational Therapy of Psoriasis</p>

“…The prevalence of psoriasis is currently estimated to be as high as 2-3% worldwide, becoming a serious global problem. [3][4][5] Moreover, it is also associated with many comorbidities such as psoriasis arthritis, 6 metabolic syndrome 7 and cardiovascular disease, 8 which brings huge health and economic burden to patients. Although various immune abnormalities have been proposed to be involved in the pathogenesis of psoriasis, 9 oxidative stress is also believed to play a pivotal role in the pathophysiological mechanism.…”