Endothelial dysfunction in psoriatic arthritis patients: relation to serum uric acid and disease activity

Abstract Background Psoriatic arthritis (PsA) is associated with increased cardiovascular risk. The role of serum uric acid (SUA) in endothelial dysfunction in PsA remains unclear. This work aimed to investigate the relationship between SUA levels, endothelial dysfunction, and disease activity in PsA patients. Patients and methods This case–control study included 50 PsA patients and 50 matched healthy controls. Carotid intima-media thickness (CIMT), lipid profiles, inflammatory markers, and SUA levels were assessed. Disease activity was evaluated using the disease activity assessment in psoriatic arthritis (DAPSA), the Psoriasis Area and Severity Index, and functional assessment was done using the Modified Health Assessment Questionnaire scores. Results PsA patients had significantly higher CIMT, SUA levels, and atherogenic lipid profiles compared to controls ( p < 0.001). Hyperuricemic PsA patients had increased CIMT and worse lipid profiles than normouricemic patients ( p < 0.001). There was a statistically significant difference in ejection fraction between the two subgroups of PsA patients as it was decreased in hyperuricemic patients. SUA levels were positively correlated with CIMT ( r = 0.734, p < 0.001), DAPSA score ( r = 0.371, p = 0.008), and total cholesterol/high-density lipoprotein risk ratio ( r = 0.312, p = 0.027). CIMT was also correlated positively with disease activity measures and lipid profile components. Multivariate analysis identified total cholesterol as the sole independent predictor of CIMT in PsA patients ( p < 0.001). Conclusion Hyperuricemia in PsA patients may represent the missing link between endothelial dysfunction, chronic inflammation, and disease activity. It could contribute to accelerated atherosclerosis in PsA patients, highlighting the importance of closely monitoring serum uric acid levels, lipid profiles, and carotid intima-media thickness alongside disease activity scores as part of their management plan.