Ghrelin and leptin in psoriatic arthritis: relationship with disease activity and cardiovascular risk

Abstract

Introduction: Evaluation and research of specific biomarkers in psoriatic arthritis (PsA) is a challenge. Ghrelin (Ghrl) is a polypeptide with cardioprotective functions, while leptin (Lep) is a pro-inflammatory cytokine with a predominant role in obesity, a condition relevant taht is essential psoriatic disease (PsD). Objectives: To evaluate Ghrl and Lep levels in patients with psoriatic arthritis (PsA) and their relationship with disease activity, metabolic state, and cardiovascular risk (CVR).

A cross-sectional study was performed at Córdoba Hospital. Patients with PsA according to CASPAR criteria were included and matched by sex and age (±3 years) with psoriasis (PsO) and control (CT) group. Sociodemographic, clinical, laboratory, and treatment variables related to PsD
were evaluated. Ghrelin and Lep samples, were analysed with a standardized procedure. Carotid ultrasound (USc) was performed to assess subclinical atherosclerosis (ATEsc), defined by intima-media thickness ≥0.9 mm and/or the presence of carotid plaques. A p-value of ≤0.05 was
considered significant.

163 patients were included: 69 PsA, 43 PsO, and 51 CT. Ghrelin level was lower in PsD patients (PsA: 199.56±37.40 pg/ml and PsO: 318.47±117.33 pg/ml) compared to CT (492.50±151.47 pg/ml; p>0.05). Leptin was significantly higher in PsD (31210.51±3730.38 ng/ml vs CT:
14707.62±6102.73 ng/ml; p=0.03). Ghrelin was negatively correlated with age and systolic blood pressure. Ghrelin was lower in patients with CVR (p>0.05). Leptin was higher in individuals with CVR factors (yes: 35823.17±3168.68 ng/ml vs no: 14707.62±6102.73 ng/ml; p=0.002) and positively
correlated with waist circumference (r=0.34; p<0.0001), body mass index (r=0.52; p<0.0001), systolic blood pressure (r=0.19; p=0.02), Health Assessment Questionnaire (r=0.28; p=0.02), eritrosedimentation rate and reactive C protein (r=0.36; p<0.0001 and r=0.36; p<0.0001), and insulin levels (r=0.36; p<0.0001). The odds ratios for PsD vs CT were: ATEsc 2.73 (95% CI 1.27-5.88); hypertension 2.47 (95% CI 1.23-4.95); obesity 2.39 (95% CI 1.20-4.78); dyslipidemia 2.22 (95% CI 1.13-4.37); metabolic syndrome 3.7 (95% CI 1.56-8.79). Ghrelin and Lep were not associated to disease activity and the presence of ATEsc.

Cardiometabolic biomarkers and USc to evaluate CVR are very important tools in PsA . Ghrelin levels were lower in PsA, and Lep levels were higher in PsD and not related to disease activity. Psoriatic arthritis and PsO had more comorbidities and higher CVR, highlighting the
importance of these methods in the evaluation, prevention, and management of PsD.