Compared with patients with psoriasis and without arthritis (PsO), patients with psoriatic arthritis (PsA) had more comorbidities and higher levels of proatherogenic lipids. Methotrexate (MTX) treatment reduced proatherogenic and anti-atherogenic lipid levels in both patient groups. The effects of MTX on lipid profiles in patient groups with PsA and Pso groups were outlined in study data published in Arthritis Research & Therapy.
This prospective study enrolled adults with PsA or PsO from the outpatient population of a major dermatology center in Shanghai, China. Patients were initiated on MTX at a starting dose of 7.5-10 mg per week, which was titrated up to a maximum weekly dose of 15 mg. Psoriasis severity was measured at baseline and 12 weeks using the Psoriasis Severity Index (PASI) and body surface area (BSA) scores. Total cholesterol, triglycerides, lipoprotein A, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL), apolipoprotein A1 (ApoA1), and ApoB were measured at the same time points. A control cohort of adult patients without psoriasis was assembled from an affiliated medical center.
Stepwise multiple regression analysis was performed to identify associations between inflammatory markers, lipid profiles, and certain cardiovascular risk factors. Models were adjusted for sex, age, age at disease onset, disease duration, body mass index (BMI), PASI and BSA scores at baseline, smoking status, alcohol use, diabetes, and hypertension.
A total of 288 patients with psoriasis were enrolled: 136 with PsA and 152 with PsO. Compared with the PsO group, the PsA group had a significantly higher mean age (50.5 ± 13.1 vs 42.8 ± 15.6 years; P <.0001), a significantly higher age at disease onset (36.0 ± 16.1 vs 31.3 ± 15.8 years; P =.0052), and a greater prevalence of hypertension (44.1 vs 27.0%; P =.0029) and hypercholesterolemia (16.9 vs 6.6%; P =.0087). Serum ApoB levels (P =.0013), total cholesterol (P =.0013), LDL (P =.0229), and ApoB/ApoA1 ratio (P =.0208) were significantly higher in PsA patients compared with PsO patients. The total psoriasis group had higher levels of pro-atherogenic lipids and lower levels of anti-atherogenic lipids compared with age- and sex-matched control participants. Across both patient groups, MTX therapy was associated with reductions in both proatherogenic and anti-atherogenic lipids. However, significant reductions in the ApoB/ApoA1 ratio were only observed in men; women with psoriasis did not experience improvements of the same magnitude, the investigators noted. In stepwise regression models, a higher ApoB/ApoA1 ratio was positively correlated with arthritis risk (P =.019), high sensitivity C-reactive protein (hCRP) levels (P =.036), diastolic blood pressure (P =.014), and weight (P =.001).
Results from this study describe baseline lipid profiles in PsO and PsA, as well as the effects of MTX therapy on lipid levels. Inflammation in psoriasis was associated with elevated levels of certain lipids; these elevated figures were effectively reduced by 12 weeks of MTX therapy.
Study limitations include the short follow-up period; the researchers suggest that further study is necessary to better assess the relationship between psoriatic inflammation and lipid levels.
MTX decreased “pro-atherogenic lipid profiles as well as anti-atherogenic lipid profiles,” investigators wrote. “The ratio of ApoB to ApoA1 was significantly downregulated in male patients with psoriasis after MTX treatment, indicating that the role of MTX on [cardiovascular disease] and other concomitant diseases might be related to sex.”
Wang B, Deng H, Hu Y, et al. The difference of lipid profiles between psoriasis with arthritis and psoriasis without arthritis and sex-specific downregulation of methotrexate on the apolipoprotein B/apolipoprotein A-1 ratio. Arthritis Res Ther. 2022;24(1):17. doi:10.1186/s13075-021-02715-4