Background: Psoriatic arthritis (PsA) is a systemic inflammatory disease increasingly recognized for its cardiovascular burden, particularly its arrhythmic complications. However, comprehensive risk stratification models integrating electrocardiographic (ECG) findings with clinical variables in PsA remain limited.
Methods: We retrospectively analyzed patients with an established diagnosis of PsA who received treatment between 2014 and 2022. A cohort of age- and sex-matched cardiovascular patients without systemic inflammatory disease served as the control group. Standard ECG parameters reflecting atrioventricular conduction as well as atrial and ventricular de- und repolarization were assessed, 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 to T-end interval (cTpTe), and QT dispersion (QTd). The control group served the validation of the predictive value of the recorded ECG parameters. In addition, clinical variables such as the duration of PsA, HLA-B27 status, the presence of cardiovascular comorbidities and the type of autoimmune therapy were recorded.
Results: A total of 725 PsA patients and 725 matched controls were included (mean age 52.5 ± 13.4 years; 61.8% female). The median PsA duration was 2 years (IQR 0–8). Rates of first-degree AVB were comparable between PsA and controls (9.5% vs. 10.2%; p = 0.725). Excluding individuals with known atrial arrhythmias, PsA patients exhibited a higher prevalence of abnormal PWTF (30.2% vs. 14.1%; p < 0.001). Furthermore, PsA patients had a longer cTpTe (0.26 ± 0.04 vs. 0.23 ± 0.05; p<0.001). Within the PsA cohort, male sex (16.4% vs. 7.1%; p = 0.006) and longer disease duration (disease duration ≥ 10 years: 18.0% vs. 6.9%; p < 0.001) were independently associated with AVB I°, even after age adjustment. Similarly, male sex (30.1% vs. 14.9%; p < 0.001) and the use of conventional synthetic disease-modifying antirheumatic drugs (25.4% vs. 16.6%; p = 0.069) were linked to a prolonged cTpTe.
Conclusions: Patients with PsA have a heightened risk of developing arrhythmias, as evidenced by abnormalities in atrial and ventricular repolarization as well as atrioventricular conduction. These findings highlight the potential role of routine, non-invasive ECG-based assessments for early identification and risk stratification of arrhythmic complications in PsA.
