Skip to main content

Advertisement

SpringerLink
Log in

Current understanding and future perspectives of brain–heart–kidney axis in psoriatic arthritis

  • Review
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Psoriatic arthritis (PsA) patients are at a higher risk of systemic inflammatory sequelae, leading to microalbuminuria, cardiovascular (CVD) and neuropsychiatric (NPD) disease. Our aim is to present the existing literature about the relationship between CVD, kidney and NPD in PsA. The literature evaluation of PsA revealed that chronic T-cell activation and increased levels of circulating immune complexes can cause glomerular injury leading to microalbuminuria, which predicts CVD and all-cause mortality in both diabetic and non-diabetic patients. Furthermore, it is a marker of preclinical brain damage and identifies patients at higher risk of NPD/CVD events. Among the currently used imaging modalities in PsA, magnetic resonance imaging (MRI) maintains a crucial role, because it is ideal for concurrent evaluation of brain/heart involvement and serial follow up assessment. There is increasing evidence regarding the relationship between kidneys, heart and brain in PsA. Although currently there are no official recommendations about a combined brain/heart MRI in PsA, it could be considered in PsA with microalbuminuria, arrhythmia, HF, cognitive dysfunction and/or depression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Langley RGB, Krueger GG, Griffiths CEM (2005) Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis 64:ii18–ii23

    PubMed  PubMed Central  Google Scholar 

  2. Mease P, Gladman D, Papp K et al (2013) Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol 69(5):729–735

    PubMed  Google Scholar 

  3. Alinaghi F, Calov M, Kristensen LE, Gladman DD, Coates LC, Jullien D, Gottlieb AB, Gisondi P, Wu JJ, Thyssen JP, Egeberg A (2019) Prevalence of psoriatic arthritis in patients with psoriasis: a systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol 80(1):251–265.e19

    PubMed  Google Scholar 

  4. Veale DJ (2013) Psoriatic arthritis: recent progress in pathophysiology and drug development. Arthritis Res Ther 15:224

    PubMed  PubMed Central  Google Scholar 

  5. Jamnitski A, Visman IM, Peters MJL, Boers M, Dijkmans BAC, Nurmohamed MT (2011) Prevalence of cardiovascular diseases in psoriatic arthritis resembles that of rheumatoid arthritis. Ann Rheum Dis 70(5):875–876

    CAS  PubMed  Google Scholar 

  6. Koraboev E (2016) Renal disorders in patients with psoriatic arthritis. Ann Rheum Dis 75:1153

    Google Scholar 

  7. Khan A, Haider I, Ayub M, Humayun M (2017) Psoriatic arthritis is an indicator of significant renal damage in patients with psoriasis: an observational and epidemiological study. Int J Inflam 2017:5217687

    PubMed  PubMed Central  Google Scholar 

  8. Kotsis K, Voulgari PV, Tsifetaki N, Machado MO, Carvalho AF, Creed F, Drosos AA, Hyphantis T (2012) Anxiety and depressive symptoms and illness perceptions in psoriatic arthritis and associations with physical health-related quality of life. Arthritis Care Res (Hoboken) 64(10):1593–6019

    Google Scholar 

  9. Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD (2011) Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int 31(11):1409–1417

    PubMed  Google Scholar 

  10. Husted JA, Thavaneswaran A, Chandran V et al (2011) Cardiovascular and other comorbidities in patients with psoriatic arthritis: a comparison with patients with psoriasis. Arthritis Care Res 63(12):1729–1735

    Google Scholar 

  11. Khalid U, Ahlehoff O, Gislason GH, Kristensen SL, Skov L, Torp-Pedersen C, Hansen PR (2014) Psoriasis and risk of heart failure: a nationwide cohort study. Eur J Heart Fail 16(7):743–748

    PubMed  Google Scholar 

  12. Dervisoglu E, Akturk AS, Yildiz K, Kiran R, Yilmaz A (2012) The spectrum of renal abnormalities in patients with psoriasis. Int Urol Nephrol 44(2):509–514

    CAS  PubMed  Google Scholar 

  13. Singh NP, Prakash A, Kubba S et al (2005) Psoriatic nephropathy—does an entity exist? Ren Fail 27(1):123–127

    CAS  PubMed  Google Scholar 

  14. Kurd SK, Gelfand JM (2009) The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003–2004. J Am Acad Dermatol 60(2):218–224

    PubMed  Google Scholar 

  15. González-Parra E, Daudén E, Carrascosa JM, Olveira A, Botella R, Bonanad C, Rivera R (2016) Kidney disease and psoriasis. A new comorbidity? Actas Dermosifiliogr 107(10):823–829

    PubMed  Google Scholar 

  16. Diercks GFH, van Boven AJ, Hillege HL, Janssen WM, Kors TJA, de Jong PE et al (2000) Microalbuminuriais independently associated with ischaemic electrocardiographic abnormalities in a large non-diabetic population the PREVEND (Prevention of Renal and Vascular Endstage Disease) study. Eur Heart J 21(23):1922–1927.14

    CAS  PubMed  Google Scholar 

  17. Festa A, Agostino R, Howard G, Mykkanen L, Tracy RP, Haffners M (2000) Inflammation and microalbuminuriain nondiabetic and type 2 diabetic subjects: the insulin resistance atherosclerosis study. Kidney Int 58(4):1703–1710.15

    CAS  PubMed  Google Scholar 

  18. Neil A, Hawkins M, Potok M, Thorogood M, Cohen D, Mann J (1993) A prospective population-based study of microalbuminuria as a predictor of mortality in NIDDM. Diabetes Care 7:996–1003

    Google Scholar 

  19. Ravera M, Ratto E, Vettoretti S, Viazzi F, Leoncini G, Parodi D, Tomolillo C, Del Sette M, Maviglio N, Deferrari G, Pontremoli R (2002) Microalbuminuria and subclinical cerebrovascular damage in essential hypertension. J Nephrol 15:519–524

    PubMed  Google Scholar 

  20. Ovbiagele B, Liebeskind DS, Pineda S, Saver JL (2010) Strong independent correlation of proteinuria with cerebral microbleeds in patients with stroke and transient ischemic attack. Arch Neurol 67(1):45–50

    PubMed  Google Scholar 

  21. Lee JL, Sinnathurai P, Buchbinder R, Hill C, Lassere M, March L (2018) Biologics and cardiovascular events in inflammatory arthritis: a prospective national cohort study. Arthritis Res Ther 20:171

    PubMed  PubMed Central  Google Scholar 

  22. Tam LS, Shang Q, Li EK et al (2008) Subclinical carotid atherosclerosis in patients with psoriatic arthritis. Arthritis Rheum 59(9):1322–1331

    PubMed  Google Scholar 

  23. Gonzalez-Juanatey C, Llorca J, Amigo-Diaz E, Dierssen T, Martin J, Gonzalez-Gay MA (2007) High prevalence of subclinical atherosclerosis in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Care Res 57(6):1074–1080

    Google Scholar 

  24. Svanteson M, Rollefstad S, Kløw NE, Jonny Hisdal J, Ikdahl E, Semb AG, Haig Y (2017) Associations between coronary and carotid artery atherosclerosis in patients with inflammatory joint diseases. RMD Open 3(2):e000544

    PubMed  PubMed Central  Google Scholar 

  25. Cavalcante L, Lima JA, Redheuil A, Al-Mallah MH (2011) Aortic stiffness: current understanding and future directions. J Am Coll Cardiol 57(14):1511–1522

    PubMed  Google Scholar 

  26. Costa L, Caso F, D’Elia L et al (2012) Psoriatic arthritis is associated with increased arterial stiffness in the absence of known cardiovascular risk factors: a case control study. Clin Rheumatol 31(4):711–715

    PubMed  Google Scholar 

  27. Shang Q, Tam LS, Yip GW, Sanderson JE, Zhang Q, Li EK, Yu CM (2011) High prevalence of subclinical left ventricular dysfunction in patients with psoriatic arthritis. J Rheumatol 38(7):1363–1370

    PubMed  Google Scholar 

  28. Lee E, Han JH, Bang CH, Yoo SA, Han KD, Kim HN, Park YM, Lee JY, Lee JH (2019) Risk of end-stage renal disease in psoriatic patients: real-world data from a nationwide population-based cohort study. Sci Rep 9(1):16581

    PubMed  PubMed Central  Google Scholar 

  29. Pana C, Hanzu-Pazara L, Duşa D, Tudorache M, Fasie D, Suta M, Tuta LA (2016) Renal comorbidity in psoriatic arthritis patients. ARS Med Tomitana 1(22):43–49

    Google Scholar 

  30. Wang CC, Tang CH, Huang KC, Huang SY, Sue YM (2018) Increased risk of incident psoriasis in end-stage renal disease patients on chronic hemodialysis: a nationwide population-based cohort study. J Dermatol 45(9):1063–1070

    PubMed  Google Scholar 

  31. Gonzalez-Juanatey C, Amigo-Diaz E, Miranda-Filloy JA et al (2006) Lack of echocardiographic and doppler abnormalities in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Semin Arthritis Rheum 35(5):333–339

    PubMed  Google Scholar 

  32. Shang Q, Tam LS, Yip GWK et al (2011) High prevalence of subclinical left ventricular dysfunction in patients with psoriatic arthritis. J Rheumatol 38(7):1363–1370

    PubMed  Google Scholar 

  33. Pines A, Ehrenfeld M, Fisman EZ (1986) Mitral valve prolapse in psoriatic arthritis. Arch Intern Med 146(7):1371–1373

    CAS  PubMed  Google Scholar 

  34. Moya JL, Sanchez M, Morales MD, Brito E (1987) Mitral valve prolapse (MVP) in psoriatic arthritis (PA). Arch Intern Med 147(5):992

    CAS  PubMed  Google Scholar 

  35. Mavrogeni SI, Kitas GD, Dimitroulas T, Sfikakis PP, Seo P, Gabriel S, Patel AR, Gargani L, Bombardieri S, Matucci-Cerinic M, Lombardi M, Pepe A, Aletras AH, Kolovou G, Miszalski T, van Riel P, Semb A, Gonzalez-Gay MA, Dessein P, Karpouzas G, Puntmann V, Nagel E, Bratis K, Karabela G, Stavropoulos E, Katsifis G, Koutsogeorgopoulou L, van Rossum A, Rademakers F, Pohost G, Lima JA (2016) Cardiovascular magnetic resonance in rheumatology: current status and recommendations for use. Int J Cardiol 217:135–148

    PubMed  Google Scholar 

  36. Mavrogeni SI, Sfikakis PP, Markousis-Mavrogenis G, Bournia VK, Poulos G, Koutsogeorgopoulou L, Karabela G, Stavropoulos E, Katsifis G, Boki K, Vartela V, Kolovou G, Theodorakis G, Kitas GD (2019) Cardiovascular magnetic resonance imaging pattern in patients with autoimmune rheumatic diseases and ventricular tachycardia with preserved ejection fraction. Int J Cardiol 284:105–109

    PubMed  Google Scholar 

  37. Markousis-Mavrogenis G, Mitsikostas DD, Koutsogeorgopoulou L, Dimitroulas T, Katsifis G, Argyriou P, Apostolou D, Velitsista S, Vartela V, Manolopoulou D, Tektonidou MG, Kolovou G, Kitas GD, Sfikakis PP, Mavrogeni SI (2020) Combined brain-heart magnetic resonance imaging in autoimmune rheumatic disease patients with cardiac symptoms: hypothesis generating insights from a cross-sectional study. J Clin Med 9(2):E447

    PubMed  Google Scholar 

  38. Ntusi NA, Francis JM, Sever E, Liu A, Piechnik SK, Ferreira VM, Matthews PM, Robson MD, Wordsworth PB, Neubauer S, Karamitsos TD (2018) Anti-TNF modulation reduces myocardial inflammation and improves cardiovascular function in systemic rheumatic diseases. Int J Cardiol 270:253–259

    PubMed  Google Scholar 

  39. Szentpetery A, Brady D, Healy G, Redmond C, Fleming H, Duignan J, Haroon M, Dodd J, FitzGerald O (2016) Higher frequency and severity of coronary plaques on coronary ct angiography in psoriatic arthritis patients without symptoms of coronary artery disease compared to controls [abstract]. Arthritis Rheumatol 68 (suppl 10). https://acrabstracts.org/abstract/higher-frequency-and-severity-of-coronary-plaques-on-coronary-ct-angiographyin-psoriatic-arthritis-patients-without-symptoms-of-coronary-artery-disease-compared-to-controls/. Accessed 27 June 2020

  40. Shen J, Wong K, Cheng IT et al (2017) Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease. Ann Rheum Dis 76:1237–1244

    CAS  PubMed  Google Scholar 

  41. Kaur S, Shafiq N, Dogra S, Mittal BR, Attri SV, Bahl A, Narang T, Vinay K, Rajagopalan S, Malhotra S (2018) 18F-fluorodeoxyglucose positron emission tomography-based evaluation of systemic and vascular inflammation and assessment of the effect of systemic treatment on inflammation in patients with moderate-to-severe psoriasis: a randomized placebo-controlled pilot study. Indian J Dermatol Venereol Leprol 84(6):660–666

    PubMed  Google Scholar 

  42. Feher A, Sinusas AJ (2017) Quantitative assessment of coronary microvascular function: dynamic single-photon emission computed tomography, positron emission tomography, ultrasound, computed tomography, and magnetic resonance imaging. Circ Cardiovasc Imaging 10(8):e006427. https://doi.org/10.1161/CIRCIMAGING.117.006427

    Article  PubMed  PubMed Central  Google Scholar 

  43. Chen KT, Chen YC, Fan YH, Lin WX, Lin WC, Wang YH, Lin L, Chiou JY, Wei JC (2018) Rheumatic diseases are associated with a higher risk of dementia: a nation-wide, population-based, case-control study. Int J Rheum Dis 21(2):373–380

    PubMed  Google Scholar 

  44. Gisondi P, Sala F, Alessandrini F, Avesani V, Zoccatelli G, Beltramello A, Moretto G, Gambina G, Girolomoni G (2014) Mild cognitive impairment in patients with moderate to severe chronic plaque psoriasis. Dermatology 228:78–85

    PubMed  Google Scholar 

  45. Miller AH, Raison CL (2016) The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol 16(1):22–34

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Wiseman SJ, Ralston SH, Wardlaw JW (2016) Cerebrovascular disease in rheumatic diseases. A systematic review and meta-analysis. Stroke 47:943–950

    PubMed  Google Scholar 

  47. Cho E, Shin H, Park S et al (2016) Albuminuria, cerebrovascular disease and cortical atrophy: among cognitively normal elderly individuals. Sci Rep 6:20692

    CAS  PubMed  PubMed Central  Google Scholar 

  48. Mavrogeni S, Koutsogeorgopoulou L, Dimitroulas T, Markousis-Mavrogenis G, Boki K, Katsifis G, Vartela V, Kallenberg CG, Kolovou G, Kitas G (2019) Combined brain/heart magnetic resonance imaging in systemic lupus erythematosus. Curr Cardiol Rev. https://doi.org/10.2174/1573403X15666190801122105

    Article  Google Scholar 

  49. Fuggle NR, Howe FA, Allen RL, Sofat N (2014) New insights into the impact of neuro-inflammation in rheumatoid arthritis. Front Neurosci 8:357

    PubMed  PubMed Central  Google Scholar 

  50. Berry C, Sidik N, Pereira AC, Ford TJ, Touyz RM, Kaski JC, Hainsworth AH (2019) Small-vessel disease in the heart and brain: current knowledge, unmet therapeutic need, and future directions. J Am Heart Assoc 8(3):e011104

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

There is no financial support for this paper and no disclosure for any of the authors.

Author information

Authors and Affiliations

  1. Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61 P. Faliro, Athens, Greece

    George Markousis-Mavrogenis, Vasiliki Vartela, Genovefa Kolovou & Sophie I. Mavrogeni

  2. Department of Rheumatology and Immunology Center, VUMC, Amsterdam, The Netherlands

    Michael T. Nurmohamed

  3. Department of Pathophysiology, Laikon Hospital, Athens, Greece

    Loukia Koutsogeorgopoulou

  4. Fourth Department of Internal Medicine, School of Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece

    Theodoros Dimitroulas

  5. Naval Hospital, Athens, Greece

    Gikas Katsifis

  6. 1st Neurology Department, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Dimos Mitsikostas

  7. Kapodistrian University of Athens, Athens, Greece

    Maria Tektonidou, Petros P. Sfikakis & Sophie I. Mavrogeni

  8. Joint Rheumatology, Laikon Hospital, Athens, Greece

    Maria Tektonidou & Petros P. Sfikakis

  9. Rheumatology Department, University of Ioannina, Ioannina, Greece

    Paraskevi Voulgari

  10. Arthritis Research UK Epidemiology Unit, Manchester University, Manchester, UK

    George D. Kitas

Authors
  1. George Markousis-Mavrogenis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael T. Nurmohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Loukia Koutsogeorgopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Theodoros Dimitroulas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gikas Katsifis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vasiliki Vartela
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dimos Mitsikostas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Genovefa Kolovou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maria Tektonidou
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Paraskevi Voulgari
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Petros P. Sfikakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. George D. Kitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Sophie I. Mavrogeni
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. GM-M: draft design and writing. MTN: draft concept and design. LK: rheumatologic literature evaluation. TD: rheumatologic Literature evaluation. GK: rheumatologic literature evaluation. VV: cardiac imaging literature evaluation. DM: neurologic literature evaluation. GK: cardiologic and nephrologic literature evaluation. MT: discussion of rheumatic findings in PsA. PV: discussion of the correlation between rheumatic and nephrologic findings in PsA. PPS: discussion of the correlation between rheumatic, cardiac and nephrologic findings in PsA. GDK: discussion of the correlation between rheumatic, cardiac and nephrologic findings in PsA. SIM: overview, final organisation and writing of the paper.

Corresponding author

Correspondence to Sophie I. Mavrogeni.

Ethics declarations

Ethical statement

In this review article sfpatients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Markousis-Mavrogenis, G., Nurmohamed, M.T., Koutsogeorgopoulou, L. et al. Current understanding and future perspectives of brain–heart–kidney axis in psoriatic arthritis. Rheumatol Int 40, 1361–1368 (2020). https://doi.org/10.1007/s00296-020-04633-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-020-04633-1

Keywords

Search

Navigation