The improvement of skin lesions in psoriasis without arthritis (PsO) was superior to that of psoriasis with arthritis (PsA) by methotrexate
Table 1 summarizes the baseline and clinical characteristics according to psoriasis subtype and sex. PsA patients had a significantly older age (p < .0001), age at disease onset (p = .0052), longer disease duration (p = .0061), and higher percentage of hypercholesterolemia (p = .0087) than PsO patients. The mean PASI score at 12 W in PsO patients (p = .0354) was significantly lower than that in PsA patients although there was no difference in PASI score at baseline. The mean PASI (p = .0236) and BSA (p = .0105) change from baseline was significantly higher in PsO patients than that in PsA patients. In addition, the percentage of hypertension in PsA patients was significantly higher than that in PsO patients (p = .0029).
Table 1
Differences in baseline characteristics between psoriasis with and without psoriatic arthritis a
Characteristic | PsA (n = 136) | PsO (n = 152) | p-valueb | Male (n = 189) | Female (n = 99) | p-valueb |
Age, mean (SD), y | 50.45 (13.12) | 42.87 (15.63) | < .0001 | 46.79 (14.72) | 45.79 (15.46) | .5627 |
Age at disease onset, mean (SD), y | 36.00 (16.07) | 31.35 (15.83) | .0052 | 35.15 (14.98) | 30.50 (17.68) | .0021 |
Disease duration, mean (SD), y | 14.51 (10.22) | 11.52 (9.89) | .0061 | 11.65 (9.27) | 15.39 (11.26) | .0089 |
Height, mean (SD), m | 1.67 (0.08) | 1.68 (0.08) | .8273 | 1.71 (0.06) | 1.60 (0.06) | < .0001 |
Weight, mean (SD), kg | 70.21 (12.28) | 69.04 (13.28) | .4500 | 73.20 (11.43) | 62.81 (12.56) | < .0001 |
BMI | 25.01 (3.44) | 24.48 (3.62) | .2158 | 24.85 (3.22) | 24.49 (4.09) | .0865 |
PASI at baseline | 14.04 (8.37) | 13.78 (5.47) | .7491 | 14.74 (7.25) | 12.29 (6.16) | .0045 |
PASI at 12W | 4.58 (4.69) | 3.55 (3.52) | .0354 | 4.41 (4.48) | 3.31 (3.29) | .0288 |
Mean PASI change from baseline, mean (SD) | 63.33 (31.50) | 70.82 (28.28) | .0236 | 66.12 (30.27) | 69.51 (29.57) | .2990 |
BSA at baseline | 26.91 (22.64) | 26.22 (17.42) | .7713 | 27.83 (20.08) | 24.08 (19.77) | .0676 |
BSA at 12W | 9.55 (16.80) | 6.75 (12.20) | .0518 | 9.11 (16.28) | 6.07 (10.45) | .0125 |
Mean BSA change from baseline, mean (SD) | 60.75 (42.16) | 71.38 (38.12) | .0105 | 65.11 (37.95) | 68.74 (44.72) | .0813 |
Cumulative dose of MTX, mean (SD), mg | 138.1 (19.85) | 138.4 (20.00) | .8869 | 139.8 (19.36) | 135.3 (20.66) | .0314 |
Hypertension | 60 (44.1) | 41(27.0) | .0029 | 71 (37.6) | 30 (30.3) | .2434 |
Diabetes | 28 (20.6) | 25 (16.4) | .4466 | 32 (16.9) | 21 (21.2) | .4240 |
Smoking | 36 (26.5) | 52 (34.2) | .1613 | 86 (45.5) | 2 (2.0) | < .0001 |
Alcohol consumption | 36 (26.5) | 44 (28.9) | .6933 | 74 (39.2) | 6 (6.1) | < .0001 |
Hypercholesterolemia (> 5.9 mmol/L) | 23 (16.9) | 10 (6.6) | .0087 | 14 (7.4) | 19 (19.2) | .0056 |
Hypertriglyceridemia (> 1.8 mmol/L) | 51 (37.5) | 42 (27.6) | .0786 | 61 (32.3) | 32 (32.3) | 1.000 |
Increased LDL (> 3.7mmol/L) | 28 (20.6) | 21 (13.8) | .1574 | 35 (18.5) | 14 (14.1) | .4106 |
Hyperlipoproteinemia (a) (> 300mg/L) | 18 (13.2) | 19 (12.5) | .8620 | 21 (11.1) | 16 (16.2) | .2662 |
Arthritis | | | | 86 (45.5) | 50 (50.5) | 0.4569 |
Male | 86 (63.2) | 103 (67.8) | 0.4569 | | | |
Abbreviation: BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); BSA, body surface area; PASI, Psoriasis Area Severity Index. |
a Data are presented as number (percentage) of patients unless otherwise indicated. |
b Mann-Whitney test, unpaired t test, or Fisher exact test were used when appropriate. P < .05 is considered to be statistically significant. |
Male patients had significantly older age at disease onset and a lower percentage of hypertryglyceridemia (p = .0056) than female (p = .0021). Several metrics were significantly higher in male patients than female patients: mean height (p < .0001), weight (p < .0001), PASI score at baseline (p = .0045), PASI score at 12W (p = .0288), BSA score at 12W (p = .0125), cumulative dose of MTX (p = .0314), smoking (p < .0001), and alcohol consumption (p < .0001).
Serum ApoB level and ApoB /ApoA1 ratio was significantly increased in psoriasis with arthritis compared to psoriasis without arthritis
Table 2 shows the difference in blood lipid profiles (ApoA1, ApoB, TC, LDL, HDL-C, Lp(a), TG) and cardiovascular risk parameters (ApoB/ApoA1, TC/HDL-C, LDL/HDL-C, LDL/ApoB) between PsA patients and sex- and age-matched healthy controls; between PsO patients and sex- and age-matched healthy controls; and between PsA patients and PsO patients. The mean values of serum ApoB (p < .0001), LDL (p = .0115) levels, ApoB/ApoA1 ratio (p < .0001), TC/HDL ratio (p = .0227), and LDL/HDL ratio (p = .0009) were significantly higher in PsA patients than those in sex- and age-matched healthy controls. However, the mean value of serum ApoA1 (p < .0001) were significantly lower in PsA patients than that in sex- and age-matched healthy controls. The mean values of serum ApoB (p < .0001), TG (p = .0098) levels, ApoB/ApoA1 ratio (p < .0001), and LDL/HDL ratio (p = .002) were significantly higher in PsO patients than those in sex- and age-matched healthy controls. The mean value of serum ApoA1 (p < .0001) level and LDL/ ApoB ratio (p < .0001) were significantly lower in PsO patients than those in sex- and age-matched healthy controls. The mean values of serum ApoB (p = .0013), TC(p = .0013), LDL (p = .0229) levels, and ApoB/ ApoA1 ratio (p = .0208) were significantly higher in PsA patients than those in PsO patients.
Table 2
The difference in blood lipid and cardiovascular risk parameters between psoriasis with and without psoriatic arthritis and healthy controls
| PsA (n = 136) | HC 1(n = 136) | PsA vs HC1 p-value | PsO (n = 152) | HC2 (n = 152) | PsO vs HC2 p-value | PsA vs PsO p-value |
ApoA1, g/L | 1.08 (0.18) | 1.21 (0.17) | < .0001 | 1.07 (0.18) | 1.20 (0.16) | < .0001 | .4496 |
ApoB, g/L | 0.76 (0.15) | 0.65 (0.13) | < .0001 | 0.70 (0.17) | 0.60 (0.12) | < .0001 | .0013 |
TC, mmol/L | 4.95 (0.89) | 4.82 (0.82) | .1939 | 4.61 (0.89) | 4.56 (0.71) | .6033 | .0013 |
TG, mmol/L | 1.74 (1.13) | 1.45 (1.07) | .0347 | 1.57 (1.02) | 1.29 (0.86) | .0098 | .1894 |
HDL-C, mmol/L | 1.23 (0.32) | 1.26 (0.26) | .3967 | 1.21 (0.29) | 1.27 (0.27) | .037 | .4731 |
LDL, mmol/L | 3.06 (0.77) | 2.83 (0.70) | .0115 | 2.84 (0.81) | 2.67 (0.65) | .0405 | .0229 |
Lp(a), mg/L | 147.9 (158.0) | 121.5 (138.8) | .1443 | 139.6 (175.2) | 125.0 (150.0) | .4364 | .6747 |
ApoB: ApoA1 ratio | 0.72 (0.19) | 0.55 (0.13) | < .0001 | 0.67 (0.19) | 0.51 (0.13) | < .0001 | .0208 |
TC: HDL ratio | 4.21 (1.07) | 3.94 (0.92) | .0227 | 3.98 (1.03) | 3.73 (0.92) | .0261 | .0603 |
LDL: HDL ratio | 2.62 (0.82) | 2.31 (0.67) | .0009 | 2.47 (0.85) | 2.19 (0.71) | .0022 | .1309 |
LDL: ApoB ratio | 4.03 (0.59) | 4.37 (0.69) | < .0001 | 4.08 (0.56) | 4.41 (0.55) | < .0001 | .4869 |
Abbreviation: ApoA1, apolipoprotein A1; ApoB, apolipoprotein B; HC, healthy controls; HDL-C, high-density lipoprotein-cholesterol; LDL: low-density lipoprotein; Lp(a), lipoprotein A; PsA: psoriatic arthritis; PsO, psoriasis without arthritis; TC, total cholesterol; TG, triglyceride; |
Mann-Whitney test, unpaired t test, unpaired t test with Welch correction were used when appropriate. P < .025 is considered to be statistically significant. |
The association of the effect of MTX on lipid profiles and cardiovascular risk parameters with psoriasis subtype and sex
Table 3 shows that MTX significantly decreased the levels of serum ApoB (p = .0003), TC (p = .0007), TG (p = .041), HDL-C (p = .037), Lp(a) (p = .0055), ApoB/ApoA1 ratio (p = .0076), and increased LDL/ApoB ratio (p = .025) in PsA patients. MTX significantly decreased the levels of serum ApoB (p < .0001), TC (p < .0001), HDL-C (p = .011), LDL (p = .0001), Lp(a) (p < .0001), and ApoB/ApoA1p = .0011). MTX increased the LDL/ApoB ratio (p = .0464) in PsO patients.
Table 3
The effect of methotrexate on lipid profiles and cardiovascular risk parameters in psoriatic patients with and without arthritis
| PsA (n = 136, 0W) | PsA (n = 136, 12W) | PsA (0W vs 12W) p-value | PsO (n = 152,0W) | PsO (n = 152,12W) | PsO (0W vs 12W) p-value |
ApoA1, g/L | 1.08 (0.18) | 1.07 (0.17) | .1026 | 1.07 (0.18) | 1.03 (0.15) | .0001 |
ApoB, g/L | 0.76 (0.15) | 0.72 (0.15) | .0003 | 0.70 (0.17) | 0.64 (0.16) | < .0001 |
TC, mmol/L | 4.95 (0.89) | 4.75 (0.89) | .0007 | 4.61 (0.89) | 4.39 (0.90) | < .0001 |
TG, mmol/L | 1.74 (1.13) | 1.61 (0.96) | .0410 | 1.57 (1.02) | 1.63 (1.86) | .6930 |
HDL-C, mmol/L | 1.23 (0.32) | 1.20 (0.30) | .0370 | 1.21 (0.29) | 1.17 (0.27) | .0110 |
LDL, mmol/L | 3.06 (0.77) | 2.96 (0.76) | .0632 | 2.84 (0.81) | 2.68 (0.81) | .0001 |
LPA, mg/L | 147.9 (158.0) | 137.1 (149.5) | .0055 | 139.6 (175.2) | 127.7 (173.9) | < .0001 |
ApoB: ApoA1 ratio | 0.72 (0.19) | 0.69 (0.17) | .0076 | 0.67 (0.19) | 0.64 (0.18) | .0011 |
TC: HDL ratio | 4.21 (1.07) | 4.13 (0.98) | .1303 | 3.98 (1.03) | 3.90 (0.18) | .1121 |
LDL: HDL ratio | 2.62 (0.82) | 2.59 (0.79) | .5030 | 2.47 (0.85) | 2.40 (0.86) | .0551 |
LDL: ApoB ratio | 4.03 (0.59) | 4.11 (0.58) | .0250 | 4.08 (0.56) | 4.14 (0.59) | .0464 |
Abbreviation: ApoA1, apolipoprotein A1; ApoB, apolipoprotein B; HC, healthy controls; HDL-C, high-density lipoprotein-cholesterol; LDL: low-density lipoprotein; Lp(a), lipoprotein A; PsA: psoriatic arthritis; PsO, psoriasis without arthritis; TC, total cholesterol; TG, triglyceride; |
Paired t test, Wilcoxon matched pairs test, Mann-Whitney test, unpaired t test, or unpaired t test with Welch correction were used when appropriate. P < .025 is considered to be statistically significant. |
Table 4 summarizes the differences and the effect of MTX on lipid profiles and cardiovascular risk parameters (ApoB/ApoA1, TC/HDL-C, LDL/HDL-C, LDL/ApoB) in male and female patients. Female patients had significantly higher levels of serum ApoA1(p < .0001), TC (p = .0241), and HDL-C(p < .0001). Women had lower ApoB/ApoA1 ratio (p = .0004), TC /HDL ratio (p < .0001), and LDL/HDL ratio (p < .0001) than men. MTX significantly decreased the levels of serum ApoA1(p = .0002), ApoB ( p < .0001), TC(p < .0001), HDL-C (p = .0029), LDL (p = .0001), Lp(a) (p = .0076), and ApoB/ApoA1 ratio (p = .0001); it increased the LDL/ApoB ratio (p = .0019) in men. MTX significantly decreased the levels of serum ApoB (p = .0214), TC (p = .0083) and Lp(a) (p = .0014) in women
Table 4
The effect of methotrexate on lipid profiles and cardiovascular risk parameters in male and female psoriatic patients
| Male (n = 189, 0W) | Male (n = 189, 12W) | Male (0W vs 12W) p-value | Female (n = 99,0W) | Female (n = 99,12W) | Female (0W vs 12W ) p-value | Male vs Female p-value |
ApoA1, g/L | 1.03 (0.16) | 1.00 (0.13) | .0002 | 1.16 (0.19) | 1.14 (0.17) | .1195 | < .0001 |
ApoB, g/L | 0.73 (0.17) | 0.67 (0.15) | < .0001 | 0.72 (0.17) | 0.69 (0.19) | .0214 | .7756 |
TC, mmol/L | 4.68 (0.85) | 4.45 (0.83) | < .0001 | 4.94 (0.98) | 4.76 (1.03) | .0083 | .0241 |
TG, mmol/L | 1.69 (1.06) | 1.68 (1.66) | .1256 | 1.57 (1.10) | 1.50 (1.14) | .1126 | .3815 |
HDL-C, mmol/L | 1.14 (0.26) | 1.10 (0.23) | .0029 | 1.37 (0.32) | 1.34 (0.31) | .1519 | < .0001 |
LDL, mmol/L | 2.94 (0.79) | 2.79 (0.74) | .0001 | 2.95 (0.81) | 2.87 (0.89) | .1342 | .8775 |
Lp(a), mg/L | 129.6 (148.6) | 119.7 (143.9) | .0076 | 170.1 (195.7) | 156.0 (191.8) | .0014 | .0399 |
ApoB: ApoA1 ratio | 0.72 (0.19) | 0.69 (0.17) | .0001 | 0.64 (0.17) | 0.62 (0.17) | .0762 | .0004 |
TC: HDL-C ratio | 4.26 (1.04) | 4.18 (1.01) | .0512 | 3.76 (1.00) | 3.68 (0.97) | .234 | < .0001 |
LDL: HDL-C ratio | 2.68 (0.84) | 2.62 (0.82) | .1057 | 2.27 (0.77) | 2.23 (0.79) | .4272 | < .0001 |
LDL: ApoB ratio | 4.04 (0.56) | 4.13 (0.56) | .0019 | 4.09 (0.61) | 4.13 (0.64) | .4161 | .2722 |
Abbreviation: ApoA1, apolipoprotein A1; ApoB, apolipoprotein B; HC, healthy controls; HDL-C, high-density lipoprotein-cholesterol; LDL: low-density lipoprotein; Lp(a), lipoprotein A; TC, total cholesterol; TG, triglyceride; |
Paired t test, or Wilcoxon matched pairs test were used when appropriate. P < .025 is considered to be statistically significant. |
The association between the inflammatory marker hCRP, lipid profiles and cardiovascular risk parameters in psoriatic patients
As shown in Table 5, stepwise regression analysis demonstrated that serum hCRP level was positively correlated with PASI score at baseline (p = .000), ApoB/ApoA1 ratio (p = .011), BMI (p = .003), and smoking (p = .015). Serum ApoA1 level was positively related with age (p = .006), negatively associated with sex (p = .015), weight (p = .004), hCRP (p = .006). Serum HDL level was negatively correlated with sex (p = .000) and weight (p = .014). Serum ApoB level was positively associated with diastolic blood pressure (p = .044), the concomitant of arthritis (p = .001) and diabetes (p = .006). Serum TC level was negatively related with sex (p = .031), and positively correlated with age (p = .000), diastolic blood pressure (p = .015), and the concomitant of arthritis (p = .002). Serum LDL level was positively associated with diastolic blood pressure (p = .003), and age at disease onset (p = .014). Serum TG level was related with diabetes (p = .000), and BMI (p = .001). ApoB/ApoA1 ratio was positively correlated with the concomitant of arthritis (p = .019), hCRP (p = .036), diastolic blood pressure (p = .014), and weight (p = .001). TC/HDL-C ratio was positively associated with sex (p = .006), diabetes (p = .008), diastolic blood pressure (p = .006), and BMI (p = .000). LDL/HDL ratio was positively related with diastolic blood pressure (p = .001), and weight (p = .000). LDL/ApoB was negatively correlated with the concomitant of hypertension (p = .021).
Table 5
The association between inflammatory marker hCRP and lipid profiles and cardiovascular risk parameters and clinic characteristics of patients with psoriasis
| | Univariate analysis | stepwise regression analysis |
| Predictors | p-value | B | 95%CI for B | p-value | B | 95%CI for B |
hCRP | PASI score at baseline | .000 | 0.142 | (0.084-0.200) | .000 | 0.144 | (0.083–0.205) |
| BMI | .001 | 0.203 | (0.079–0.328) | .003 | 0.195 | (0.065–0.324) |
| ApoB/ApoA1 | .000 | 4.009 | (1.777–6.241) | .011 | 3.153 | (0.746–5.56) |
| Smoking | .022 | 0.821 | (0.119–1.522) | .015 | 0.841 | (0.165–1.518) |
ApoA1 | Sex | .000 | -0.128 | (-0.129–0.086) | .001 | -0.091 | (-0.142–0.039) |
| Age | .000 | 0.003 | (0.002–0.004) | .006 | 0.002 | (0.001–0.004) |
| Weight | .000 | -0.005 | (-0.006–0.003) | .004 | -0.003 | (-0.005–0.001) |
| hCRP | .003 | -0.012 | (-0.02–0.004) | .006 | -0.011 | (-0.018–0.003) |
HDL | Sex | .000 | -0.228 | (-0.297–0.159) | .000 | -0.008 | (-0.011–0.005) |
| Weight | .000 | -0.010 | (-0.013–0.008) | .014 | -0.096 | (-0.173–0.019) |
ApoB | diabstolic blood pressure | .003 | 0.003 | (0.001–0.005) | .044 | 0.002 | (0.000-0.004) |
| arthritis | .001 | 0.063 | (0.025–0.101) | .001 | 0.084 | (0.036–0.131) |
| Diabetes | .001 | 0.081 | (0.032–0.130) | .006 | 0.090 | (0.026–0.154) |
TC | Sex | .024 | -0.252 | (-0.471–0.033) | .031 | -0.253 | (0.483–0.023) |
| Age | .000 | 0.017 | (0.011–0.024) | .000 | 0.016 | (0.009–0.024) |
| Diastolic blood pressure | .013 | 0.013 | (0.003–0.023) | .015 | 0.012 | (0.002–0.021) |
| Arthritis | .001 | 0.339 | (0.133–0.545) | .002 | 0.225 | (0.002–0.448) |
LDL | Diastolic blood pressure | .001 | 0.015 | (0.006–0.024) | .003 | 0.014 | (0.005–0.023) |
| Age at disease onset | .010 | 0.008 | (0.002–0.013) | .014 | 0.008 | (0.002–0.015) |
TG | Diabetes | .000 | 0.657 | (0.344–0.970) | .000 | 0.604 | (0.025–0.095) |
| BMI | .000 | 0.068 | (0.033–0.103) | .001 | 0.060 | (0.025–0.095) |
ApoB/ApoA1 | Arthritis | .021 | 0.052 | (0.008–0.096) | .019 | 0.066 | (0.011–0.120) |
| hCRP | .000 | 0.015 | (0.007–0.023) | .036 | 0.009 | (0.001–0.018) |
| Diastolic blood pressure | .000 | 0.004 | (0.002–0.006) | .014 | 0.003 | (0.001–0.005) |
| Weight | .000 | 0.005 | (0.004–0.007) | .001 | 0.004 | (0.001–0.006) |
TC/HDL-C | Sex | .000 | 0.504 | (0.253–0.754) | .006 | 0.016 | (0.005–0.027) |
| Diabetes | .001 | 0.516 | (0.207–0.825) | .008 | 0.460 | (0.121–0.799) |
| Diastolic blood pressure | .000 | 0.024 | (0.013–0.036) | .006 | 0.016 | (0.005–0.027) |
| BMI | .000 | 0.109 | (0.077–0.142) | .000 | 0.087 | (0.050–0.125) |
LDL/HDL-C | Diastolic blood pressure | .000 | 0.021 | (0.012–0.030) | .001 | 0.019 | (0.008–0.030) |
| Weight | .000 | 0.025 | (0.018–0.032) | .000 | 0.020 | (0.010–0.030) |
LDL/ApoB | Hypertension | .016 | -0.172 | (-0.310–0.033) | .021 | -0.168 | (-0.310–0.026) |
Abbreviation: ApoA1, apolipoprotein A1; ApoB, apolipoprotein B; HC, healthy controls; HDL-C, high-density lipoprotein-cholesterol; LDL: low-density lipoprotein; Lp(a), lipoprotein A; TC, total cholesterol; TG, triglyceride; |
Stepwise multiple regression analysis was performed after adjustment for sex, age, age at disease onset, disease duration, BMI, PASI and BSA scores at baseline, smoking, alcohol, diabetes, hypertension. Only the significant variables are shown. P < .05 is considered to be statistically significant. |