Endothelial Dysfunction and Accelerated Atherosclerosis in Psoriasis and Psoriatic Arthritis: Bridging Dermatology, Rheumatology, and Vascular Medicine

Abstract

Background: Chronic inflammatory diseases such as Psoriasis and Psoriatic Arthritis are also being recognized as systemic diseases and not those that are limited to the skin and joints. The already growing amount of evidence indicates that the illnesses are comorbid with the issues of cardiovascular complications, i.e., endothelial dysfunction of the endothelium and a timely atherosclerosis. Extensive systemic inflammation, disrupted metabolism, and lifestyle-related risk factors are some of the factors contributing to vascular damage, leading to increased morbidity and mortality. Although the severity of the disease, metabolic factors, and cardiovascular risks were raised, the exact correlation of the disease severity and the metabolic factors with cardiovascular risks has yet to be optimally studied in most of the clinical populations. Hence, the research was conducted in order to formulate the connections between psoriasis and psoriatic arthritis as well as endothelial dysfunction in the domains of dermatology, rheumatology, and vascular medicine.

Objective: The main aim of the research was to evaluate the linkage between the severity of inflammatory diseases in both psoriasis and psoriatic arthritis and the risk of endothelial dysfunction and increased atherosclerosis. The secondary findings of the research were the assessments of the impact of metabolic (BMI, hypertension, diabetes) and lifestyle (smoking, physical activity, diet) factors and cardiovascular awareness.

Methods: The design of the study article was the cross-sectional type, which was carried out in the outpatient department of dermatology as well as rheumatology in tertiary care hospitals. The purposive sampling method was employed to ensure that the respondents were 215 in number, made up of psoriatic arthritis and/or psoriasis. The data were collected in the form of a structured questionnaire, where the data were gathered as demographic variables, disease characteristics, metabolic risk factors, and behaviors related to cardiovascular health. The Likert-scale questions were used to measure the knowledge, lifestyle behavior, and symptoms regarding the vascular malfunction. The statistical analysis involved descriptive statistics, tests of normality, reliability analysis (Cronbach's alpha), validity tests (KMO and Bartlett test), and inferential tests, which included independent samples t-test, one-way ANOVA, Chi-square test of independence, Pearson correlation, and multiple regression analysis.

Results: The results obtained revealed that most of the variables were normally distributed, meaning that there was an opportunity to use the tests that are parametric. The results of the reliability analysis show high internal consistency of the constructs of the questionnaire with a high level of Cronbach's alpha (over 0.80). Construct validity was validated through running a test of Bartlett (p < 0.05), and construct validity based on the use of a KMO (>0.80) and sampling adequacy was verified. The inferential analysis showed that the level of diseases was high in the demographic and lifestyle group, which had statistically significant differences between the interviewees' metabolic risk factors. A high prevalence of psoriasis and the severity of psoriatic arthritis were also noted to be significantly related to physical inactivity, obesity, and smoking. The chi-square analysis revealed that lipid disorders and hypertension were significantly related to diabetes cases in the scenario of smoking. The outcomes of the correlation study indicated weak and moderate positive correlations between the body surface area, which is modified by psoriasis, and cardiovascular awareness and severity of psoriasis. The severity of psoriasis, the severity of psoriatic arthritis, the body mass index (BMI), the joint involvement, as well as the symptoms of circulation were all significantly positively predictive risks of endothelial dysfunction. Both the hypothesis of the inflammatory burden and the vascular pathology hypothesis were proved to be true using the regression model, and found that it had a substantial percentage of cardiovascular risk variables forecasted by itself.

Conclusion: They conclude from the study that psoriasis and psoriatic arthritis are directly related to cardiovascular risks due to permanent chronic systemic inflammation, and the disruption of metabolism and lifestyle changes. The interactive mechanism of inflammatory illness to the endothelium dysfunctions contributes to the cognitive activities of higher atherosclerosis in patients. Early detection of the risk factors and the ways of managing them is necessary in conjunction with the involvement of dermatologists, rheumatologists, and the representatives of the cardiovascular sources to minimize the number of complications in the long-run.