Background: Psoriatic arthritis (PsA) is a chronic inflammatory systemic disease that is associated with cardiovascular complications, particularly with an increased risk of arrhythmias. Despite the evidence, a structured, population-based risk stratification that relates electrocardiographic (ECG) parameters to clinical characteristics in PsA is still lacking.
Methods: Patients diagnosed with PsA between 2014 and 2022 were enrolled, if ECG-data was available. An age- and gender-matched group of cardiovascular patients without systemic inflammatory disease served as control group. A variety of established ECG-parameters associated with atrial and ventricular re-/depolarization as well as atrioventricular conduction were evaluated, including interatrial block (IAB), p wave peak time (PWPT), p wave terminal force (PWTF), p wave dispersion (PWd), atrioventricular block (AVB), corrected QT-interval (QTc), corrected T peak-T end (cTpTe) and QT dispersion (QTd). The control group served to validate the predictive value of the recorded ECG parameters. In addition, clinical variables such as duration of PsA, HLA-B27 status, the presence of cardiovascular comorbidities, and the type of autoimmune therapy were recorded.
Results: A total of 621 patients with PsA alongside 621 matched cardiovascular patients were enrolled (mean age 51.6±14.9 years, female gender 55.4%). The median duration of PsA was 2 years (IQR 0-8), while the HLA-B27 antigen was positive in 20.8% of the population. Patients with PsA had similar rates of AVB I ° (11.3 vs. 11.8%; p =0.859) with the control group. After excluding patients with known atrial arrhythmias, PsA patients had higher rates of IAB (9.7 vs. 2.0%; p<0.001) and of significant PWTF (29.5 vs. 14.1%; p<0.001) compared to the control group. Furthermore, PsA patients had a longer QTc (485.4 ± 63.1 vs. 413.7 ± 34.5 ms; p<0.001) as well as longer cTpTe (0.22 ± 0.04 vs. 0.19 ± 0.04; p<0.001). Among PsA patients, the presence of HLA-B27 (19.6 vs. 9.2%; p=0.049) as well as a longer duration of the disease (10.4 ± 12.1 vs. 5.3 ± 8.3 years; p=0.004) were associated with AVB I°, even after adjusting for age. Furthermore, the use of disease modifying antirheumatic drugs correlated to AVB I° (17.2 vs. 7.8%; p=0.013), as well as a prolonged cTpTe (74.7 vs. 59.2%, p=0.021).
Conclusion: Patients with PsA are at an increased risk for arrhythmias, demonstrated by disorders of both atrial and ventricular re-/depolarization. The possible proarrhythmic effects of newer anti-inflammatory drugs need to be further elucidated. Non-invasive, ECG-based tools for structured risk stratification could facilitate the early detection of patients at risk.
