Vol.:(0123456789) 1 3 Rheumatology International https://doi.org/10.1007/s00296-020-04633-1 REVIEW Current understanding and future perspectives of brain–heart–kidney axis in psoriatic arthritis George Markousis‑Mavrogenis 1  · Michael T. Nurmohamed 2  · Loukia Koutsogeorgopoulou 3  · Theodoros Dimitroulas 4  · Gikas Katsifis 5  · Vasiliki Vartela 1  · Dimos Mitsikostas 6  · Genovefa Kolovou 1  · Maria Tektonidou 7,8  · Paraskevi Voulgari 9  · Petros P. Sfikakis 7,8  · George D. Kitas 10  · Sophie I. Mavrogeni 1,7 Received: 18 April 2020 / Accepted: 17 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Psoriatic arthritis (PsA) patients are at a higher risk of systemic inflammatory sequelae, leading to microalbuminuria, car- diovascular (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. 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 Introduction Psoriasis is a chronic inflammatory disease of the skin with an estimated prevalence of 2–3% in the general population [1]. Its incidence peaks in adulthood and it is one of the most common causes of morbidity worldwide [1]. Psoriasis occurs due to T-cell-mediated immune responses and may have systemic manifestations including a particular type of associated arthritis (psoriatic arthritis-PsA). Epidemiologic estimates of PsA remain difficult to determine, particularly due to the lack of definitive diagnostic tests and the heteroge- neous clinical manifestations of the disease, which may lead to misclassification and underdiagnosis [2]. However, the most conclusive estimates from a recent meta-analysis place its prevalence at approximately 25% of psoriatic patients [3], making PsA the second most common type of inflammatory arthritis after rheumatoid arthritis (RA) [4]. PsA patients may often develop cardiovascular disease (CVD), renal impairment, expressed as microalbuminuria and/or cerebrovascular disease [5–8]. Most recently, another systemic manifestation of psoriasis, neuropsychiatric dis- ease (NPD), is increasingly being recognized [8]. The aim of this review is to present the existing literature regarding the relationship between CVD, NPD and renal disease in patients with PsA. Research strategy A MedLine, Embase and Scopus search were performed according to published guidance on narrative reviews [9] using the following terms: psoriasis, psoriatic arthritis, car- diovascular involvement, microalbuminuria, central nerv- ous system involvement, cognitive dysfunction, depres- sion, central nervous system magnetic resonance imaging, Rheumatology INTERNATIONAL * Sophie I. Mavrogeni soma13@otenet.gr Extended author information available on the last page of the article