Abstract
IntroductionA higher prevalence of metabolic syndrome (MetS) has been described in rheumatoid arthritis (RA), along with an association with disease activity. Objectives were to describe prevalence of MetS at RA diagnosis in a cohort of Mexican Mestizo early RA patients, and to define a causal association between MetS and disease activity.MethodsThe study population was a prospective cohort. At baseline and at fixed 6-months-intervals, patients had medical evaluations, fasting serum glucose, triglycerides, high-density lipoprotein cholesterol and acute reactant-phase determinations. MetS was defined according to international criteria and body mass index (BMI) ≥30 kg/m2 was used as a surrogate of the waist circumference. The study was approved by the internal review board. Appropriated statistics and Cox regression analysis were used. All statistical tests were two-sided and evaluated at the 0.05 significance level.ResultsUp to March 2014, data from 160 patients were analyzed. At baseline, they were more frequently middle-aged females and had moderate to high disease activity. Prevalence of MetS varied from 11.3% to 17.5% in patients and was lower to that from matched controls (versus 26.3% to 30%, P ≤0.01).Up to last follow-up, 39 patients (34.5%) developed incidental MetS. In the Cox regression analysis, cumulative disease activity score (DAS) 28 (odds ratio (OR): 1.81, 95% confidence interval (CI): 1.346 to 2.433, P = 0.000) and baseline BMI (OR: 1.13, 96% CI: 1.035 to 1.236, P = 0.007) were the only predictors for incidental MetS.RA patients with incidental MetS accumulated more disease activity and had less frequent remission than their counterparts. Logistic regression analysis showed that incidental MetS (OR: 0.2, 95% CI: 0.01 to 0.99, P = 0.052) and baseline DAS28 (OR: 0.4, 95% CI: 0.2 to 0.9, P = 0.02) were the only predictors for achieving or maintaining sustained (≥6 months) remission.ConclusionsMetS prevalence in a cohort of early RA patients was lower than that from matched controls. Cumulative disease activity and higher BMI were risk factors for incidental Mets; higher baseline disease activity and incidental MetS prevented sustained remission. In addition to disease activity, MetS needs to be controlled to impact disease outcomes.
Highlights
A higher prevalence of metabolic syndrome (MetS) has been described in rheumatoid arthritis (RA), along with an association with disease activity
antibodies to cyclic citrullinated proteins (ACCP), antibodies to cyclic citrullinated peptides; AHA/NHLBI, American Heart Association/ National Heart, Lung and Blood Institute; BMI, body mass index; CRP, C-reactive protein; DAS28, disease activity score evaluated in 28 joints; disease-modifying anti-rheumatic drug (DMARD), diseasemodifying anti-rheumatic drug; ESR, erythrocyte sedimentation rate; HAQ, Health Assessment Questionnaire; MetS, metabolic syndrome; NA, not applicable; RF, rheumatoid factor. aComparison between rheumatoid arthritis patients with/without MetS
ACCP, antibodies to cyclic citrullinated peptides; BMI, body mass index; CRP, C-reactive protein; DAS28, disease activity score evaluated in 28 joints; DMARD, disease-modifying anti-rheumatic drug; ESR, erythrocyte sedimentation rate; HAQ, Health Assessment Questionnaire; MetS, metabolic syndrome; RF, rheumatoid factor. aConsidered up to MetS diagnosis in patients with incidental MetS and up to last follow-up in the patients without incidental MetS
Summary
A higher prevalence of metabolic syndrome (MetS) has been described in rheumatoid arthritis (RA), along with an association with disease activity. Objectives were to describe prevalence of MetS at RA diagnosis in a cohort of Mexican Mestizo early RA patients, and to define a causal association between MetS and disease activity. It has been proposed that metabolic syndrome (MetS) should be added to the list; in the general population, MetS identifies patients at risk of developing coronary heart disease later in life, with a relative risk of 2.7 [12]. Regarding prevalence of MetS in RA, there have been conflicting results but the most recent meta-analysis of 12 observational, cross-sectional studies involving 2,283 Caucasian and Asian RA patients showed a significantly increased prevalence when compared with 4,403 controls [14]. Additional studies have found association with some components of the MetS and disease activity [17,18,19], the cross-sectional design of the studies prevents identification of causal associations
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