A recent study published in Rheumatic and Musculoskeletal Diseases Open has revealed distinct lipid abnormalities in patients with early, treatment-naïve psoriatic arthritis (PsA), shedding light on potential new diagnostic markers. The findings suggest that PsA patients exhibit a unique lipid profile characterized by lower levels of apolipoprotein A1 (ApoA1) and higher levels of apolipoprotein B (ApoB), differentiating them from both rheumatoid arthritis (RA) patients and healthy individuals. These lipid disturbances could have implications for both disease pathogenesis and cardiovascular risk assessment in PsA.
The study compared the lipid profiles of newly diagnosed, untreated PsA patients with age- and sex-matched healthy controls and early RA patients. While traditional lipid markers, such as high-density lipoprotein cholesterol (HDL-c), were significantly lower in PsA patients compared to controls and RA patients, more striking differences emerged in apolipoprotein levels. ApoB levels were elevated in PsA patients relative to RA but remained lower than in healthy individuals. In contrast, ApoA1 was markedly reduced in PsA patients compared to both RA patients and healthy controls.
Further analysis showed that ApoA1 levels were highly predictive of a PsA diagnosis, with an accuracy of over 90%. When adjusted for additional factors, ApoA1 demonstrated strong diagnostic potential, with a sensitivity of 83.8% and a specificity of 82.4% at an optimal threshold. These results indicate that measuring apolipoproteins may offer a more precise assessment of lipid disturbances in PsA than conventional lipid markers.
Lipoproteins are molecular complexes composed of various lipids—including phospholipids, cholesterol, and triglycerides (TAG)—along with diverse, multifunctional proteins known as apolipoproteins. They play a crucial role in lipid transport and the regulation of lipid metabolism. ApoB is a key component of proatherogenic lipoproteins, such as very low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and intermediate-density lipoproteins (IDL). In contrast, ApoA1 is primarily associated with high-density lipoproteins (HDL), which are considered anti-atherogenic.
A previous study by Wang et al. found that psoriatic patients had higher pro-atherogenic lipid levels and lower anti-atherogenic lipid levels compared to healthy controls, with PsA patients showing a higher ApoB/ApoA1 ratio than psoriasis without arthritis (PsO) patients. This supports the notion that PsA is not only an inflammatory arthritis but also a condition with metabolic alterations that may predispose patients to an increased cardiovascular burden.
The presence of a pro-atherogenic lipid profile in early PsA highlights the need for a broader approach to managing cardiovascular risk in these patients. Given the altered lipid metabolism observed, early intervention with lipid-lowering strategies could play a crucial role in reducing long-term cardiovascular complications associated with PsA. Furthermore, these findings emphasize the importance of incorporating apolipoprotein measurements into clinical practice, potentially improving early diagnosis and personalized treatment strategies for PsA patients.
By identifying distinct lipid patterns in PsA, this study paves the way for further research into the mechanisms linking lipid metabolism, inflammation, and autoimmunity, which may ultimately lead to novel therapeutic targets.
References
- Ishchenko A, Van Mechelen M, Storms L, de Vlam K, Pazmino S, Neerinckx B, et al. Low apolipoprotein A1 and high apolipoprotein B levels indicate specific lipid changes in treatment naïve early psoriatic arthritis. RMD Open. 2025 Jan 8;11(1):e005174.
- Wang B, Deng H, Hu Y, Han L, Huang Q, Fang X, et al. The difference of lipid profiles between psoriasis with arthritis and psoriasis without arthritis and sex-specific downregulation of methotrexate on the apolipoprotein B/apolipoprotein A-1 ratio. Arthritis Res Ther. 2022 Jan 7;24(1):17.