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Psoriatic Arthritis – You Make My Heart Skip a Beat!

November 9 2015 5:00 PM ET via RheumReports RheumReports

When one thinks of psoriatic arthritis (PsA), one may think of scaly, itchy skin rashes, swollen joints, dactylitis, and back pain as several of many possible clinical manifestations of the disease. But did you ever think it might make your patient's heart skip a beat – or several? Or set their hearts "aflutter"? Literally??

Dr. Karin Bengsston (Abstract #1059) certainly thought of this possibility. She and her group from Sweden looked at the association between conduction disorders and ankylosing spondylitis (AS), psoriatic arthritis (PsA) and undifferentiated spondylarthritis (USpA) in a cohort of Swedish patients with these rheumatic conditions compared to a general population cohort. There is already a known association between conduction disorders such as AV block and atrial fibrillation among patients with AS, but this has been less studied in other SpA groups. Part of this increased risk has been attributed to the presence of HLA-B27. The objective of this study was to assess if there is an increased risk of AV block, atrial fibrillation and flutter, as well as the need for pacemaker insertion, in patients with AS, PsA or USpA compared to the general population.

The study group gleaned their data from the Swedish National Patient Registry, and using an algorithm of diagnostic codes, they extracted data regarding patients with SpA and conduction defects. Data for the general population was taken from the general population register. Overall, they analyzed data for over 6000 patients with AS, over 4000 patients with SpA and over 16000 patients with PsA, from 2004-2012. In patients with AS, PsA, as well as USpA, there was an increased number of cases of AV block, atrial fibrillation, atrial flutter, as well as pacemaker insertion, compared to the general population. For example, in male AS patients as well as patients with USpA, the risk of AV block was increased 3-fold compared to the general population. All types of AV block were noted.

So what does this mean for our patients? Will this change the way you monitor your patients with PsA, AS and USpA? This brings up the important topic of managing comorbidities in rheumatology patients, in particular cardiovascular risk factors. Will an ECG be part of your standard workup?


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About the Author

Dr. Pari Basharat
Dr. Pari Basharat

Dr. Pari Basharat, BSc, MD is a Rheumatologist based in London, ON.

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