Impact of Therapy on Metabolic Syndrome in Young Adult Premenopausal Female Lupus Patients: Beneficial Effect of Antimalarials.

Abstract

There are no data about the main factors associated with metabolic syndrome in young premenopausal systemic lupus erythematosus (SLE) patients. The aim of the study was to evaluate the frequency of metabolic syndrome and disease- or therapy-related factors in premenopausal young SLE patients. A total of 103 premenopausal SLE patients ages <40 years were selected and compared to 35 healthy premenopausal age-matched women. Metabolic syndrome was defined according to the 2009 Joint Interim Statement. A higher frequency of metabolic syndrome (22.3% versus 5.7%; P = 0.03) was observed in the SLE group. Metabolic syndrome-SLE patients had higher SLE Disease Activity Index scores (mean ± SD 5.9 ± 7.6 versus 1.9 ± 2.7; P = 0.006), more frequently had previous renal disease (73.9% versus 51.2%; P = 0.05) and current renal disease (34.8% versus 10.0%; P = 0.008), and had higher current prednisone dose (median [range] 20 [0-60] versus 5 [0-60] mg/dl; P = 0.018) and cumulative prednisone dose (mean ± SD 41.48 ± 27.81 versus 24.7 ± 18.66 gm; P = 0.023) than those without metabolic syndrome. Chloroquine was less frequently used in metabolic syndrome-SLE patients (65.2% versus 90.0%; P = 0.008). In multivariate analysis, only current chloroquine use (prevalence ratio [PR] 0.29, 95% confidence interval [95% CI] 0.13-0.64) and cumulative prednisone were associated with metabolic syndrome (PR 1.02, 95% CI 1.01-1.04). Further estimated prevalence analysis identified the fact that antimalarial use promoted continuous decrease in the progressive metabolic syndrome prevalence associated with glucocorticoid cumulative dose. The prevalence of metabolic syndrome is high in premenopausal young adult SLE patients. Chloroquine has a protective effect on the prevalence of metabolic syndrome in these patients, and this benefit counteracts the deleterious effect of glucocorticoids in a dose-dependent manner.