Keywords
psoriatic arthritis
arterial stiffness
vascular ageing
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Abstract
Background: Spondyloarthritis, including ankylosing spondylitis (AS) and psoriatic arthritis (PsA), is associated with increased cardiovascular risk that may not be fully captured by conventional risk assessment tools. Arterial stiffness and carotid intima–media thickness (CIMT) represent early markers of vascular ageing; however, direct comparisons of local carotid biomechanical properties between AS and PsA remain limited. Objectives: To compare structural and functional carotid vascular parameters derived from one-point echo-tracking ultrasound between patients with AS and PsA and to explore clinical, metabolic and haemodynamic correlates of arterial stiffness. Methods: In this cross-sectional study, 108 patients with spondyloarthritis (71 AS, 37 PsA) underwent vascular ultrasound assessment including CIMT, local pulse wave velocity (PWVβ), β-stiffness index, Peterson’s elastic modulus (Ep), arterial compliance (AC) and augmentation index (AI). Clinical characteristics, inflammatory markers, lipid profile and cardiovascular risk scores were recorded. Between-group comparisons were performed using non-parametric tests. Spearman correlations and multivariable linear regression analyses were applied to identify factors associated with vascular parameters. Results: Baseline demographic and metabolic characteristics were comparable between groups, although sex distribution differed (p = 0.002). Most structural and functional vascular indices, including CIMT, PWVβ, β-stiffness index, AC and Ep, did not differ significantly between AS and PsA. Augmentation index was higher in PsA compared with AS (median 21.9 vs 12.8, p = 0.029). CIMT correlated positively with β-stiffness index (ρ = 0.404), PWVβ (ρ = 0.482) and Ep (ρ = 0.451) (all p < 0.001). In multivariable regression models, arterial hypertension emerged as the most consistent independent factor associated with vascular parameters, while inflammatory markers showed limited associations. Conclusion: Patients with ankylosing spondylitis and psoriatic arthritis demonstrate broadly comparable local carotid vascular profiles when assessed using echo-tracking ultrasound. Higher augmentation index in psoriatic arthritis suggests differences in haemodynamic wave reflection rather than intrinsic arterial stiffness. Vascular alterations appear to be driven predominantly by haemodynamic and metabolic factors rather than disease phenotype alone.
References
1. Angelov AK, Markov M, Ivanova M, Georgiev T. The genesis of cardiovascular risk in inflammatory arthritis: insights into glycocalyx shedding, endothelial dysfunction, and atherosclerosis initiation. Clin Rheumatol. 2023;42:2541–2555
2. Miroslav M, Georgiev T, Angelov A, et al. Adhesion molecules and atherosclerosis in ankylosing spondylitis: implications for cardiovascular risk. Rheumatol Int. 2024;44:1837-1848.
3. Peters MJ, Visman I, Nielen MM, et al. Ankylosing spondylitis: a risk factor for myocardial infarction? Ann Rheum Dis. 2010;69:579–81.
4. Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, Nurmohamed MT. Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum. 2004;34:585-92.
5. Haroon NN, Paterson JM, Li P, Inman RD, Haroon N. Patients with ankylosing spondylitis have increased cardiovascular and cerebrovascular mortality: a population-based study. Ann Intern Med. 2015;163:409-416.
6. Haroon NN, et al. Increased risk of cardiovascular and cerebrovascular diseases in individuals with ankylosing spondylitis: a population-based study. Arthritis Rheum. 2011;63:3294-3304.
7. Wright KA, Crowson CS, Michet CJ, Matteson EL. Time trends in incidence, clinical features and cardiovascular disease in ankylosing spondylitis over 3 decades: a population based study. Arthritis Care Res. 2015;67:836-41.
8. Mathieu S, Pereira B, Soubrier M. Cardiovascular events in ankylosing spondylitis: an updated meta-analysis. Semin Arthritis Rheum. 2015;44(5):551–5.
9. Helon K, Wisłowska M, Kanecki K, Goryński P, Nitsch-Osuch A, Bonek K. Time Trend Analysis of Comorbidities in Ankylosing Spondylitis: A Population-Based Study from 53,142 Hospitalizations in Poland. J Clin Med. 2024;13(2):602.
10. Chaudhary H, Bohra N, Syed K, Donato A, Murad MH, Karmacharya P. All-Cause and Cause-Specific Mortality in Psoriatic Arthritis and Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2023 May;75(5):1052-1065.
11. Shah K, Paris M, Mellars L, Changolkar A, Mease PJ. Real-world burden of comorbidities in US patients with psoriatic arthritis. RMD Open. 2017 Dec 28;3(2):e000588.
12. Polachek A, Touma Z, Anderson M, et al. Risk of cardiovascular morbidity in patients with psoriatic arthritis: a meta-analysis of observational studies. Arthritis Care Res. 2017;69:67-74.
13. Huang H, Xie W, Geng Y, Fan Y, Zhang Z. Mortality in patients with psoriatic arthritis: a systematic review and meta-analysis. Front Immunol. 2025 Aug 18;16:1622159.
14. Franklin SS, Gustin W, Wong ND, et al. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation. 1999;100(4):423-429.
15. Mitchell GF, Hwang SJ, Vasan RS, et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation. 2010;121(4):505-511.
16. Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part II: The aging heart in health: links to heart disease. Circulation. 2003;107(2):346-354.
17. Erdinç Hatipsoylu, İlker Şengül, Taciser Kaya, Altınay Göksel Karatepe, Seniz Akçay, Leyla Isayeva, Giray Bozkaya, Erhan Tatar. Assessment of subclinical atherosclerotic cardiovascular disease in patients with ankylosing spondylitis. Anatol J Cardiol. 2019; 22(4): 185-191.
18. Dzieża-Grudnik A, Sulicka J, Strach M, Siga O, Klimek E, Korkosz M, Grodzicki T. Arterial stiffness is not increased in patients with short duration rheumatoid arthritis and ankylosing spondylitis. Blood Press. 2017 Apr;26(2):115-121.
19. Costa, L., Caso, F., D’Elia, L. et al. Psoriatic arthritis is associated with increased arterial stiffness in the absence of known cardiovascular risk factors: a case control study. Clin Rheumatol 31, 711–715 (2012).
20. Vriz O, et al. Comparison of sequentially measured Aloka echo-tracking one-point pulse wave velocity with SphygmoCor carotid-femoral pulse wave velocity. SAGE Open Med. 2013;1.
21. Mather K, Lewanczuk R. Measurement of arterial stiffness in diabetes. Diabetes Care. 2004;27.
22. Sugawara J, Hayashi K, Yokoi T, Tanaka H. Age-associated elongation of the ascending aorta in adults. JACC Cardiovasc Imaging. 2008:739–748.
23. Laurent S, Boutouyrie P, Asmar R, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37(5):1236-41.
24. Willeit P, Tschiderer L, Allara E, et al. Carotid Intima-Media Thickness Progression as Surrogate Marker for Cardiovascular Risk: Meta-Analysis of 119 Clinical Trials Involving 100 667 Patients. Circulation. 2020 Aug 18;142(7):621-642.
25. Bauer M, Caviezel S, Teynor A, Erbel R, Mahabadi AA, Schmidt-Trucksäss A. Carotid intima-media thickness as a biomarker of subclinical atherosclerosis. Swiss Med Wkly. 2012 Oct 25;142:w13705. doi: 10.4414/smw.2012.13705. PMID: 23135891.
26. Nichols WW, O'Rourke MF, Vlachopoulos C. McDonald's blood flow in arteries: theoretical, experimental and clinical principles. CRC Press; 2011.
27. Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol. 2005;25(5):932-943.
28. Safar ME. Arterial stiffness as a risk factor for clinical hypertension. Nat Rev Cardiol. 2018 Feb;15(2):97-105.
29. Pusztai, A., Hamar, A., Czókolyová, M. et al. Associations of vascular and bone status in arthritis patients. Sci Rep 2021;11:19504.
30. Shen J, Shang Q, Li EK, et al. Cumulative inflammatory burden is independently associated with increased arterial stiffness in patients with psoriatic arthritis: a prospective study. Arthritis Res Ther. 2015;17:75.
31. Serdaroğlu Beyazal, M., Erdoğan, T., Türkyılmaz, A.K. et al. Relationship of serum osteoprotegerin with arterial stiffness, preclinical atherosclerosis, and disease activity in patients with ankylosing spondylitis. Clin Rheumatol. 2016;35:2235–2241.
32. Soy, M., Yildiz, M., Sevki Uyanik, M., Karaca, N., Güfer, G., & Piskin, S. (2009). Susceptibility to atherosclerosis in patients with psoriasis and psoriatic arthritis as determined by carotid-femoral (aortic) pulse-wave velocity measurement. Revista Española de Cardiología, 62(1), 96-99.
33. Moyssakis I, Gialafos E, Vassiliou VA, Boki K, Votteas V, Sfikakis PP, Tzelepis GE. Myocardial performance and aortic elasticity are impaired in patients with ankylosing spondylitis. Scand J Rheumatol. 2009;38(3):216-21.
34. Sylvain Mathieu, Bruno Pereira, Marion Couderc, et al. No significant changes in arterial stiffness in patients with ankylosing spondylitis after tumour necrosis factor alpha blockade treatment for 6 and 12 months, Rheumatology (Oxford), 2013;52(1):204–209,
35. Karkucak M, Çapkin E, Kiriş A, et al. Arterial stiffness and anti-tumor necrosis factor-alpha therapy in ankylosing spondylitis: Results with long-term two year-follow-up. Archives of Rheumatology. 2014;29(4):250-56.
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Copyright (c) 2026 Miroslav Markov, Tsvetoslav Georgiev, Maria Dimova, Maria Kosturkova (Author)