Is Ghrelin a biomarker in psoriatic arthritis?

Abstract

Psoriatic disease (PDs), which includes psoriasis (PsO) and psoriatic arthritis (PsA), is usually associated with cardiometabolic comorbidities. Ghrelin (Ghrl) is a polypeptide with cardioprotective, immunomodulatory and anti-inflammatory effects. Few studies have explored the relationship with PsO and none with PsA. Our objective was to evaluate ghrelinemia in patients with PsA, its relationship with disease activity, metabolic and cardiovascular status.

A prospective case-control cross-sectional study was performed (between 7/2019 and 3/2022). Sixty-nine PsA patients matched by sex and age with PsO (n=43) and controls (CT; n=51) were included. Patients with another inflammatory joint disease were excluded. Activity was evaluated by PASI (psoriasis area severity index), DAPSA (disease activity for psoriatic arthritis) and MDA (minimal disease activity). Subclinical atherosclerosis (SCate) was defined according to myointimal thickening ≥0.9mm and/or presence of carotid plaque by ultrasound (excluding those with a previous cardiovascular event), and metabolic syndrome (MetS) by ATPIII. ANOVA or Kruskall-Wallis tests were applied and p<0.05 was considered significant. The study was approved by the ethics committee of Hospital Córdoba and authors have no conflicts of interest.

Ghrl concentrations were markedly lower in patients with PDs (APs:199.56±37.40pg/ml; PsO:318.47±117.33pg/ml and TC:492.50±151.47pg/ml), although without statistical significance. Ghrl tended to be higher in patients with MDA (p>0.05) and no differences were found between groups according to PASI or DAPSA. Patients with PsA and PsO showed a higher frequency of ATEsc than CT (57% and 68% vs 36%, respectively; p<0.05) and Ghrl concentrations in patients with ATEsc and MetS tended to be lower. Ghrelin was significantly lower in patients with hypertension (149.57±139.13pg/ml vs 489.03±110.70pg/ml, n=52 and 78 respectively, p<0.05) and was negatively correlated with systolic blood pressure (r=-0.19; p<0.05).

This is the first study to explore the association between PsA and Ghrl, suggesting a negative association between the polypeptide, disease severity, and metabolic/cardiovascular risk. If these trends are confirmed in a higher number of patients, Ghrl might be a candidate biomarker in PsA, as well as play a physiopathogenic role in PDs.