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

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.

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

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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.

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Correspondence to Sophie I. Mavrogeni.

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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 (2020). https://doi.org/10.1007/s00296-020-04633-1

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Keywords

  • Central nervous system magnetic resonance imaging
  • Cardiovascular magnetic resonance imaging
  • Psoriatric arthritis
  • Central nervous system disease
  • Cardiovascular disease
  • Cognitive dysfunction
  • Depression
  • Arrhythmia
  • Heart failure