Взаимосвязь ожирения, кардиометаболических нарушений и активности заболевания у больных псориатическим артритом: данные Общероссийского регистра

Корсакова Ю.Л., Коротаева Т.В., Логинова Е.Ю., Губарь Е.Е., Василенко Е.А., Василенко А.А., Кузнецова Н.А., Патрикеева И.М., Насонов Е.Л. Взаимосвязь ожирения, кардиометаболических нарушений и активности заболевания у больных псориатическим артритом: данные Общероссийского регистра. Терапевтический архив. 2021; 93 (5): 573–580. DOI: 10.26442/00403660.2021.05.200789

________________________________________________

Korsakova YuL, Korotaeva TV, Loginova EIu, Gubar EE, Vasilenko EA, Vasilenko AA, Kuznetsova NA, Patrikeeva IM, Nasonov EL. The relationship between obesity, cardiometabolic disorders and disease activityin psoriatic arthritis patients: data from the Russian register. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (5): 573–580. DOI: 10.26442/00403660.2021.05.200789

Читать PDF

Аннотация

Цель. Изучить взаимосвязь ожирения, кардиометаболических нарушений и активности заболевания у больных псориатическим артритом (ПсА) в реальной практике.
Материалы и методы. В Общероссийский регистр включены 614 больных ПсА [жен/муж – 331 (54%)/283 (46%)]. Средний возраст – 45,2±0,52 года, длительность ПсА – 5,7±0,27 года, псориаза – 15,71±0,56 года. Больным проводили обследование, оценивали индекс массы тела (ИМТ), активность ПсА по DAPSA, cDAPSA, анализ сопутствующих заболеваний. Пациенты были разделены на 3 группы в зависимости от ИМТ (кг/м2): нормальный <25 (1-я группа), повышенный – 25–30 (2-я группа), ожирение >30 (3-я группа).
Результаты. Среднее значение ИМТ составило 27,7±0,23 кг/м2, нормальный ИМТ – у 213 (34,7%), повышенный – у 214 (34,8%) и ожирение – у 187 (30,5%). Сопутствующие заболевания – у 297 (48%). В 3-й группе достоверно чаще, чем в 1 и 2-й, наблюдалась артериальная гипертензия (р<0,0001); чаще, чем во 2-й группе, – сахарный диабет (р<0,0001), метаболический синдром (р<0,0001); чаще, чем в 1-й группе, – ишемическая болезнь сердца (р=0,026). Активность ПсА на момент начала наблюдения, через 6 и 12 мес была значимо выше в 3-й группе (p<0,031). У больных с ожирением шанс снижения активности заболевания до умеренного/низкого уровня и ремиссии на фоне терапии в течение 6 и 12 мес в 2,484 раза ниже, чем в 1 группе, и в 2,346 раза ниже, чем во 2-й группе: отношение шансов 2,346 (95% доверительный интервал 1,07–5,143) и 2,484 (95% доверительный интервал 1,135–5,439) соответственно.
Заключение. У большинства (65,3%) больных ПсА ИМТ превышал норму. Ожирение ассоциируется с высокой частотой кардиометаболических нарушений, с более высокой активностью ПсА и меньшей эффективностью лечения.

Ключевые слова: регистр больных псориатическим артритом, псориатический артрит, индекс массы тела, кардиометаболические нарушения, активность псориатического артрита

________________________________________________

Aim. To study the relationship between obesity, cardiometabolic disorders and disease activity in patients with psoriatic arthritis (PsA) in real practice.
Materials and methods. The Russian register included 614 PsA patients [female – 331 (54%)/283 (46%)]. Average age – 45.2±0.52 years, PsA duration – 5.7±0.27 years, psoriasis – 15.71±0.56 years. Patients underwent examination, body mass index (BMI), PsA activity according to DAPSA, cDAPSA, analysis of concomitant diseases were assessed. The patients were divided into 3 groups depending on BMI (kg/m2): normal
<25 (group 1), increased – 25–30 (group 2), obesity >30 (group 3).
Results. The average BMI was 27.7±0.23 kg/m2, normal BMI – in 213 (34.7%), increased – in 214 (34.8%) and obesity – in 187 (30.5%). Concomitant diseases – in 297 (48%). In group 3, arterial hypertension was observed significantly more often than in groups 1 and 2 (p<0.0001); more often than in group 2 – diabetes mellitus (p<0.0001), metabolic syndrome (p<0.0001); more often than in group 1 – ischemic heart disease (p=0.026). PsA activity at Baseline, after 6/12 months was significantly higher in group 3 (p<0.031). In obese patients, the chance of a decrease in disease activity to a moderate/low level and remission during therapy for 6/12 months is 2.484 times lower than in group 1, and 2.346 times lower than in group 2: odds ratio 2.346 (95% сonfidence interval 1.07–5.143) and 2.484 (95% сonfidence interval 1.135–5.439), respectively.
Conclusion. In the majority (65.3%) of PsA patients, BMI exceeded the norm. Obesity is associated with a high incidence of cardiometabolic disorders, with higher PsA activity and lower treatment efficacy.

Keywords: register of psoriatic arthritis patients, psoriatic arthritis, body mass index, cardiometabolic disorders, psoriatic arthritis activity

Список литературы

1. Noviani M, Feletar M, Nash P, et al. Choosing the right treatment for patients with psoriatic arthritis. Ther Adv Musculoskel Dis. 2020;12:1-17. DOI:10.1177/1759720X20962623
2. Ogdie A, Yu Y, Haynes K, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis. 2015;74(2):326-32. DOI:10.1136/annrheumdis-2014-205675
3. Husni ME, Mease PJ. Managing comorbid disease in patients with psoriatic arthritis. Curr Rheumatol Rep. 2010;12(4):281-7. DOI:10.1007/s11926-010-0112-3
4. Bengtsson K, Forsblad-d’Elia H, Lie E, et al. Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Res Ther. 2017;19:102. DOI:10.1186/s13075-017-1315-z
5. Eder L, Thavaneswaran A, Chandran V, et al. Increased burden of inflammation over time is associated with the extent of atherosclerotic plaques in patients with psoriatic arthritis. Ann Rheum Dis. 2015;74:1830-5. DOI:10.1136/annrheumdis-2014-205267
6. Bhole VM, Choi HK, Burns LC, et al. Differences in body mass index among individuals with PsA, psoriasis, RA and the general population. Rheumatology (Oxford). 2012;51:552-6. DOI:10.1093/rheumatology/ker349
7. Bostoen J, Van Praet L, Brochez L, et al. A cross-sectional study on the prevalence of metabolic syndrome in psoriasis compared to psoriatic arthritis. J Eur Acad Dermatol Venereol. 2014;28:507-11. DOI:10.1111/jdv.12071
8. Labitigan M, Bahče-Altuntas A, Kremer JM, et al. Higher rates and clustering of abnormal lipids, obesity, and diabetes mellitus in psoriatic arthritis compared with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2014;66:600-7. DOI:10.1002/acr.22185
9. Haroon M, Gallagher P, Heffernan E, FitzGerald O. High prevalence of metabolic syndrome and of insulin resistance in psoriatic arthritis is associated with the severity of underlying disease. J Rheumatol. 2014;41:1357-65. DOI:10.3899/jrheum.140021
10. Eder L, Abji F, Rosen CF, et al. The association between obesity and clinical features of psoriatic arthritis: a case-control study. J Rheumatol. 2017;44:437-43. DOI:10.3899/jrheum.160532
11. Landgren AJ, Bilberg A, Eliasson B, et al. Cardiovascular risk factors are highly overrepresented in Swedish patients with psoriatic arthritis compared with the general population. Scand J Rheumatol. 2020;49(3):195-9. DOI:10.1080/03009742.2019.1672783
12. Nissen CB, Hørslev-Petersen K, Primdahl J. Cardiovascular risk profiles in a hospital-based population of patients with psoriatic arthritis and ankylosing spondylitis: a cross-sectional study. Rheumatol Int. 2017;37(1):113-20. DOI:10.1007/s00296-016-3614-0
13. Hellgren K, Dreyer L, Arkema EV, et al. Cancer risk in patients with spondyloarthritis treated with TNF inhibitors: a collaborative study from the ARTIS and DANBIO register. Ann Rheum Dis. 2017;76(1):105-11. DOI:10.1136/annrheumdis-2016-209270
14. Taylor WJ, Gladman DD, Helliwell PS, et al. Classiﬁcation criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54:2665-73. DOI:10.1002/art.21972
15. Schoels MM, Aletaha D, Alasti F, et al. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis. 2016;75(5):811-8. DOI:10.1136/annrheumdis-2015-207507
16. Aletaha D, Alasti F, Smolen JS. Disease activity states of the DAPSA, a psoriatic arthritis specific instrument, are valid against functional status and structural progression. Ann Rheum Dis. 2017;76(2):418-21. DOI:10.1136/annrheumdis-2016-209511
17. Smolen JS, Schols M, Braun J, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018;77:3-17. DOI:10.1136/annrheumdis-2017-211734
18. Horn EJ, Fox KM, Patel V, et al. Association of patient-reported psoriasis severity with income and employment. J Am Acad Dermatol. 2007;57(6):963-71. DOI:10.1016/j.jaad.2007.07.023
19. Fredriksson T, Pettersson U. Severe psoriasis oral therapy with a new retinoid. Dermatologica. 1978;157(4):238-44. DOI:10.1159/000250839
20. Davidovici BB, Sattar N, Prinz J, et al. Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co‐morbid conditions. J Invest Dermatol. 2010;130:1785-96. DOI:10.1038/jid.2010.103
21. Grozdev I, Korman N, Tsankov N. Psoriasis as a systemic disease. Clin Dermatol. 2014;32:343-50. DOI:10.1016/j.clindermatol.2013.11.001
22. Boehncke WH. Systemic inflammation and cardiovascular comorbidity in psoriasis patients: causes and consequences. Front Immunol. 2018;9:579. DOI:10.3389/fimmu.2018.00579
23. Krueger JG, Brunner PM. Interleukin‐17 alters the biology of many cell types involved in the genesis of psoriasis, systemic inflammation and associated comorbidities. Exp Dermatol. 2018;27:115-23. DOI:10.1111/exd.13467
24. Prussick RB, Miele L. Nonalcoholic fatty liver disease in patients with psoriasis: a consequence of systemic inflammatory burden? Br J Dermatol. 2018;179:16-29. DOI:10.1111/bjd.16239
25. Gisondi P, Del Giglio M, Girolomoni G. Considerations for systemic treatment of psoriasis in obese patients. Am J Clin Dermatol. 2016;17:609-15. DOI:10.1007/s40257-016-0211-7
26. Danielsen K, Wilsgaard T, Olsen AO, et al. Elevated odds of metabolic syndrome in psoriasis: a population‐based study of age and sex differences. Br J Dermatol. 2015;172:419-27. DOI:10.1111/bjd.13288
27. Takahashi H, Iizuka H. Psoriasis and metabolic syndrome. J Dermatol. 2012;39:212-8. DOI:10.1111/j.1346-8138.2011.01408.x
28. Carrascosa JM, Rocamora V, Fernandez‐Torres RM, et al. Obesity and psoriasis: inflammatory nature of obesity, relationship between psoriasis and obesity, and therapeutic implications. Actas Dermosifiliogr. 2014;105:31-44. DOI:10.1016/j.ad.2012.08.003
29. Bluher M. Adipose tissue inflammation: a cause or consequence of obesity‐related insulin resistance? Clin Sci. 2016;130:1603-14. DOI:10.1038/ncomms11378
30. Ali M, Girgis S, Hassan A, et al. Inflammation and coronary artery disease: from pathophysiology to Canakinumab Anti‐Inflammatory Thrombosis Outcomes Study (CANTOS). Coron Artery Dis. 2018;29:429-37. DOI:10.1097/MCA.0000000000000625
31. Shoelson SE, Goldfine AB. Getting away from glucose: fanning the flames of obesity‐induced inflammation. Nat Med. 2009;15:373-4. DOI:10.1038/nm0409-373
32. Xu X, Su L, Gao Y, Ding Y. The prevalence of nonalcoholic fatty liver disease and related metabolic comorbidities was associated with age at onset of moderate to severe plaque psoriasis: a cross‐sectional study. PLoS ONE. 2017;12:e0169952. DOI:10.1371/journal.pone.0169952
33. Srinivas S, Nagendra S, Goudappala, Kashinath RT. Alterations in plasma lipid profile and cardiovascular risk indicators in clinically sub-grouped psoriasis. Int J Res Dermatol. 2019;5(2):295-9. DOI:10.18203/issn.2455-4529.IntJResDermatol20190429
34. Amer M, Galal A, Amer A. Psoriasis Severity is Affected by T the Lipid Profile in Egyptian Patients. Gynecol Obstet (Sunnyvale). 2015;5(12):1-3. DOI:10.4172/2161-0932.1000346
35. Azevedo VF, Buiar P. Risk factors and predictors of psoriatic arthritis in patients with psoriasis. An Bras Dermatol. 2013;88(2):233-6. DOI:10.1590/S0365-05962013000200008
36. Li W, Han J, Qureshi AA. Smoking and risk of incident psoriatic arthritis in US women. Ann Rheum Dis. 2012;71(6):804-8. DOI:10.1136/annrheumdis-2011-200416
37. Lihi Eder L, Haddad A, Rosen CF, et al. The Incidence and Risk Factors for Psoriatic Arthritis in Patients With Psoriasis: A Prospective Cohort Study. Arthritis Rheumatol. 2016;68(4):915-23. DOI:10.1002/art.39494
38. Kimball AB, Gladman DD, Gelfand JM, et al. National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. J Am Acad Dermatol. 2008;58:1031-42. DOI:10.1016/j.jaad.2008.01.006
39. Vena GA, Vestita M, Cassano N. Psoriasis and cardiovascular disease. Dermatol Ther. 2010;23:144-51. DOI:10.1111/j.1529-8019.2010.01308.x
40. Prodanovich S, Kirsner R, Kravetz J, et al. Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality. Arch Dermatol. 2009;145:700-3. DOI:10.1001/archdermatol.2009.94
41. Tobin AM, Veale DJ, Fitzgerald O, et al. Cardiovascular disease and risk factors in patients with psoriasis and psoriatic arthritis. J Rheumatol. 2010;37:1386-94. DOI:10.3899/jrheum.090822
42. Eder L, Zisman D, Barzilai M, et al. Subclinical atherosclerosis in psoriatic arthritis: a case‐control study. J Rheumatol. 2008;35:877-82. PMID: 18381785
43. Kay L, Myers A, Walker D. Effects of inflammatory arthritis on quality of life in patients with psoriasis [letter]. Arch Dermatol. 2003;139:1655. DOI:10.1001/archderm.139.12.1655-a
44. Ciocon DH, Horn EJ, Kimball AB. Quality of life and treatment satisfaction among patients with psoriasis and psoriatic arthritis and patients with psoriasis only: results of the 2005 Spring US National Psoriasis Foundation Survey. Am J Clin Dermatol. 2008;9:111-7. DOI:10.2165/00128071-200809020-00004
45. Christophers E, Barker JN, Griffiths CE, et al. The risk of psoriasis arthritis remains constant following initial diagnosis of psoriasis among patients seen in European dermatology clinics. J Eur Acad Dermatol Venereol. 2010;24:548-54. DOI:10.1111/j.1468-3083.2009.03463.x
46. Husted J, Thavaneswaran A, Chandran V, et al. Cardiovascular and other comorbidities in patients with psoriatic arthritis: A comparison with patients with psoriasis. Arthritis Care Res. 2011;63(12):1729-35. DOI:10.1002/acr.20627
47. Erden A, Canpolat U, Uyaroğlu OA, et al. Change of subclinical atherosclerosis after five years anti-TNF treatments in psoriatic arthritis. Ann Rheum Dis. 2019;78(Suppl. 2):1269. DOI:10.1136/annrheumdis-2019-eular.6044
48. Di Minno MN, Peluso R, Iervolino S, et al. Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor alpha blockers. Ann Rheum Dis. 2014;73(6):1157-62. DOI: 10.1136/annrheumdis-2012-202812
49. Klingberg E, Bilberg A, Björkman S, et al. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Res Ther. 2019;21:17. DOI:10.1186/s13075-019-1810-5
50. Abou-Raya A, Abou-Raya S, Helmii M. Effect of Exercise and Dietary Weight Loss on Symptoms and Systemic Inflammation in Obese Adults with Psoriatic Arthritis: Randomized Controlled Trial. Ann Rheum Dis. 2014;73(Suppl. 2):89-90. DOI:10.1136/annrheumdis-2014-eular.2760.
51. Giles JT, Ogdie A, Gomez Reino JJ, et al. Impact of baseline body mass index on the efficacy and safety of tofacitinib in patients with psoriatic arthritis. RMD Open. 2021;7:e001486. DOI:10.1136/rmdopen-2020-001486

________________________________________________

Авторы

Ю.Л. Корсакова*1, Т.В. Коротаева1, Е.Ю. Логинова1, Е.Е. Губарь1, Е.А. Василенко2, А.А. Василенко3, Н.А. Кузнецова4, И.М. Патрикеева5, Е.Л. Насонов1,6

1 ФГБНУ«Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
2 ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия;
3 ГОБУЗ «Новгородская областная клиническая больница», Великий Новгород, Россия;
4 ГАУЗ Свердловской области «Городская клиническая больница №40», Екатеринбург, Россия;
5 ГБУЗ Тюменской области «Областная клиническая больница №1», Тюмень, Россия;
6 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
yulkorsakova@bk.ru

________________________________________________

Yuliia L. Korsakova*1, Tatiana V. Korotaeva1, Elena Iu. Loginova1, Elena E. Gubar1, Elizaveta A. Vasilenko2, Aleksei A. Vasilenko3, Natalia A. Kuznetsova4, Irina M. Patrikeeva5, Evgeny L. Nasonov1,6

1 Nasonova Research Institute of Rheumatology, Moscow, Russia;
2 Mechnikov North-Western State Medical University, Saint Petersburg, Russia;
3 Novgorod Regional Clinical Hospital, Veliky Novgorod, Russia;
4 City Clinical Hospital №40, Ekaterinburg, Russia;
5 Regional Clinical Hospital №1, Tyumen, Russia;
6 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
yulkorsakova@bk.ru

Назад к списку

Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.