PsA confers substantial excess cardiovascular risk comparable to other inflammatory arthropathies, and biologic DMARDs modestly reduce cardiovascular events, supporting their role in comprehensive PsA management.
Key Findings
Results
Patients with psoriatic arthritis had significantly higher rates of major adverse cardiovascular events (MACE) compared to propensity-matched controls.
HR for MACE was 1.74 in PsA patients versus controls
Incidence rates were 62.9 vs. 36.4 per 1,000 person-years for MACE
Study used 1:1 propensity-score matching of 123,031 PsA patients to 123,031 controls without PsA
Cox proportional hazards models were used to estimate hazard ratios
Data were drawn from the TriNetX Global Health Research Network covering 2002–2025
Results
All-cause mortality was substantially higher in PsA patients than in matched controls.
HR for all-cause mortality was 1.95
Incidence rates were 60.2 vs. 31.0 per 1,000 person-years
This nearly two-fold excess mortality was observed after propensity-score matching on demographics, comorbidities, and medications
Results
PsA patients experienced significantly higher rates of heart failure, myocardial infarction, and stroke compared to controls.
HR for heart failure was 1.96
HR for myocardial infarction was 1.71
HR for stroke was 1.49
All comparisons were made in propensity-matched cohorts of 123,031 pairs
Results
The excess cardiovascular risk observed in PsA was robust to the potential influence of unmeasured confounding.
E-values ranged from 2.5 to 3.9 across the various cardiovascular outcomes
E-values indicate the minimum strength of association an unmeasured confounder would need to have with both treatment and outcome to explain away the observed results
Higher E-values indicate greater robustness to unmeasured confounding
Results
Biologic DMARD (bDMARD) treatment was associated with a modest reduction in MACE and all-cause mortality compared to conventional synthetic DMARD treatment within the PsA cohort.
HR for MACE with bDMARDs vs. conventional synthetic DMARDs was 0.95
HR for all-cause mortality with bDMARDs vs. conventional synthetic DMARDs was 0.92
Comparison was made in 1:1 propensity-score matched groups of 44,870 bDMARD-treated versus 44,870 conventional synthetic DMARD-treated PsA patients
Matching was performed on demographics, comorbidities, and medications within the PsA cohort
Tyczyńska K, Krajewski P, Złotowska A, Szepietowski J, Świerkot J. (2026). Excess cardiovascular morbidity in psoriatic arthritis and cardioprotective effects of biologic dmards: a propensity-matched analysis.. Scientific reports. https://doi.org/10.1038/s41598-026-38565-w