METABOLIC SYNDROME IN YOUNG RHEUMATOID ARTHRITIS PATIENTS
AbstractBackground: Metabolic Syndrome is strongly associated with Rheumatoid Arthritis, which significantly increases cardiovascular complications and hence morbidity and mortality. Treating Metabolic Syndrome decreases cardiovascular related disease flares and deaths. This study evaluates prevalence of metabolic syndrome in young Rheumatoid Arthritis patients. Methods: This Cross-sectional study was conducted in rheumatology department of a tertiary care hospital in Karachi. All diagnosed cases of rheumatoid arthritis from April to August 2018 were consecutively included. Disease activity of rheumatoid arthritis assessed by Clinical Disease Activity Index (CDAI). Associate determinants of rheumatoid arthritis were measured along with outcome variables. Results: Out of 104 rheumatoid arthritis patients, 34 (32.7%) found to have metabolic syndrome in whom 20 (58.8%) of patients were seropositive. A significant association of metabolic syndrome was found with age (p-value 0.023), BMI (p-value 0.006), waist circumference (p-value 0.002), FBS (p-value <0.001), SBP (p-value <0.001), DBP (p-value <0.001), TG (p-value <0.001), HDL (p-value 0.022), and Methotrexate drug history (p-value 0.030). Conclusion: We conclude that metabolic syndrome is highly prevalent in young rheumatoid patients with rheumatoid arthritis. Treating Metabolic Syndrome decreases cardiovascular related disease flares and deaths. This young population base study will help out to estimate the exact burden of Metabolic Syndrome to decrease overall morbidity and mortality.Keywords: Rheumatoid Arthritis; Metabolic Syndrome; Cardiovascular disease
Giles JT, Bartlett SJ, Andersen RE, Fontaine KR, Bathon JM. Association of body composition with disability in rheumatoid arthritis: impact of appendicular fat and lean tissue mass. Arthritis Rheum 2008;59(10):1407–15.
Tutuncu Z, Kavanaugh A. Rheumatic disease in the elderly: rheumatoid arthritis. Rheum Dis Clin North Am 2007;33:57–70.
Genta MS, Genta RM, Gabay C. Systemic rheumatoid vasculitis: a review. Semin Arthritis Rheum 2006;36(2):88–98.
Peters MJ, Symmons DP, McCarey D, Dijkmans BA, Nicola P, Kvien TK, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inﬂammatory arthritis. Ann Rheum Dis 2010;69(2):325–31.
Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2011;25(4):469–83.
Meune C, Touzé E, Trinquart L, Allanore Y. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology (Oxford) 2009;48(10):1309–13.
Ku IA, ImbodenJB, HsuePY, Ganz P. Rheumatoid arthritis a model of systemic inflammation driving atherosclerosis. Circ J 2009;73(6):977–85.
Evans MR, Escalante A, Battafarano DF, Freeman GL, O'Leary DH, del Rincón I, et al. Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. Arthritis Rheum 2011;63(5):1211–20.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285(19):2486–97.
Kassi E, Pervanidou P, Kaltsas G, Chrousos G. Metabolic syndrome: definitions and controversies. BMC Med 2011;9:48.
Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular disease: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation 2001;104:2855–64.
Misra A, Khurana L. The metabolic syndrome in South Asians: epidemiology, determinants, and prevention. Metab Syndr Relat Disord 2009;7(6):497–514.
Katulanda P, Ranasinghe P, Jayawardana R, Sheriff R, Matthews DR. Metabolic syndrome among Sri Lankan adults: prevalence, patterns and correlates. Diabetol Metab Syndr 2012;4(1):24.
Dao HH, Do QT, Sakamoto J. “Increased frequency of metabolic syndrome among Vietnamese women with early rheumatoid arthritis: a cross-sectional study,” Arthritis Res Ther 2010;12(6):218.
Solomon A, Christian BF, Norton GR, Woodiwiss AJ, Dessein PH. Risk factor profiles for atherosclerotic cardiovascular disease in black and other Africans with established rheumatoid arthritis. J Rheumatol 2010;37(5):953–60.
Karvounaris SA, Sidiropoulos PI, Papadakis JA, Spanakis EK, Bertsias GK, Kritikos HD, et al. Metabolic syndrome is common among middle-to-older aged Mediterranean patients with rheumatoid arthritis and correlates with disease activity: a retrospective, cross sectional, controlled, study. Ann Rheum Dis 2007;66(1):28–33.
Chung CP, Oeser A, SolusJF, Avalos I, Gebretsadik T, Shintani A, et al. Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis. Atherosclerosis 2008;196(2):756–63.
da Cunha VR, Brenol CV, Brenol JC, Fuchs SC, Arlindo EM, Melo IM, et al. Metabolic syndrome prevalence is increased in rheumatoid arthritis patients and is associated with disease activity. Scand J Rheumatol 2012;41(3):186–91.
Di Micco P, Ferrazzi P, Libre L, Mendolicchio L, Quaglia I, De Marco M, et al. Intima-media thickness evolution after treatment with infliximab in patients with rheumatoid arthritis. Int J Gen Med 2009;2:141–4.
Reiss AB, Carsons SE, Anwar K, Rao S, Edelman SD, Zhang H, et al. Atheroprotective effects of methotrexate on reverse cholesterol transport proteins and foam cell transformation in human THP-1 monocyte/macrophages. Arthritis Rheum 2008;58(12):3675–83.
Jick SS, Choi H, Li L, McInnes IB, Sattar N. Hyperlipidaemia, statin use and the risk of developing rheumatoid arthritis. Ann Rheum Dis 2009;68(4):546–51.
McCareyDW, McInnesIB, Madhok R, Hampson R, Scherbakov O, Ford I, et al. Trial of Atorvastatin in Rheumatoid Arthritis (TARA): double-blind, randomised placebo-controlled trial. Lancet 2004;363(9426):2015–21.
de Oliveira BMGB, Medeiros MM das C, de Cerqueira JVM, de Souza Quixadá RT, de Oliveira ÍMX. Metabolic syndrome in patients with rheumatoid arthritis followed at a University Hospital in Northeastern Brazil. Rev Bras Reumatol Engl Ed 2016;56(2):117–25.
Rostom S, Mengat M, Lahlou R, Hari A, Bahiri R, Hajjaj-Hassouni N. Metabolic syndrome in rheumatoid arthritis: case control study. BMC Musculoskelet Disord 2013;14:147.