Assessment of Subclinical Coronary Atherosclerosis in Patients with Psoriasis and Psoriatic Arthritis; Do Biologics Play a Role?

Background: Psoriatic arthritis (PsA) is a psoriasis-related inflammatory condition that significantly accelerates the onset of cardiovascular disease (CVD) via systemic inflammation and traditional risk factors. Pro-inflammatory cytokines like TNF and IL-17 are implicated in endothelial dysfunction and atherosclerosis, pointing to the utilization of targeted therapies. Objective: This study investigates the effect of biologic agents on coronary atherosclerosis and left ventricular function in PsA patients using multislice CT coronary angiography (CCTA) and its correlation with disease activity scores. Patients and methods: This cross-sectional study recruited 60 asymptomatic psoriatic patients with established PsA, without known cardiac, metabolic, or autoimmune comorbidities. Comprehensive clinical, laboratory, and cardiovascular evaluations, which included speckle tracking echocardiography and multislice CT coronary angiography, were conducted at baseline and after one-year follow-up. Disease severity was measured in terms of PASI, DAPSA, and CASPAR criteria to compare skin/joint involvement with cardiovascular risk. Results: At baseline, treatment groups were comparable in demographics and disease severity. After one-year, anti-IL17 therapy significantly improved joint disease (DAPSA), skin disease (PASI) and left ventricular systolic function, and reduced coronary plaque burden more than anti-TNF or conventional treatments. Longer biologic treatment duration was independently associated with reduced cardiovascular risk, highlighting the cardio-protective effect of sustained biologic therapy. Conclusion: Anti-IL17 therapy shows superior benefits in reducing joint disease activity, skin disease, and cardiovascular risk in PsA patients compared to anti-TNF and conventional treatments, supporting its role in comprehensive PsA care.