EXTENDED REPORT

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

S A Karvounaris^1,*, P I Sidiropoulos^1,*, J A Papadakis², E K Spanakis¹, G K Bertsias¹, H D Kritikos¹, E S Ganotakis², D T Boumpas²

¹ Division of Rheumatology, Clinical Immunology and Allergy, University Hospital, Medical School, University of Crete, Heraklion, Greece
² Departments of Internal Medicine, Clinical Immunology and Allergy, University Hospital, Medical School, University of Crete, Heraklion, Greece

Correspondence to:
Dr D T Boumpas
Department of Internal Medicine, Division of Rheumatology, Clinical Immunology and Allergy, University of Crete, Medical School, Voutes 71500, Heraklion, Greece; boumpasd{at}med.uoc.gr

Objectives: Patients with rheumatoid arthritis have an increased risk for cardiovascular disease (CVD). The prevalence of metabolic syndrome (MetS)—a major contributor to CVD—in a cohort of patients with rheumatoid arthritis and its relationship with rheumatoid arthritis related factors is investigated here.

Methods: 200 outpatients with rheumatoid arthritis (147 women and 53 men), with a mean (standard deviation (SD)) age of 63 (11) years, and 400 age and sex-matched controls were studied. MetS was assessed according to the adult treatment panel III criteria and rheumatoid arthritis disease activity by the disease activity score of 28 joints (DAS28). A standard clinical evaluation was carried out, and a health and lifestyle questionnaire was completed.

Results: The overall prevalence of MetS was 44% in patients with rheumatoid arthritis and 41% in controls (p = 0.5). Patients with rheumatoid arthritis were more likely to have low high-density lipoprotein cholesterol compared with controls (p = 0.02), whereas controls were more likely to have increased waist circumference or raised blood pressure (p = 0.001 and 0.003, respectively). In multivariate logistic regression analysis adjusting for demographics and rheumatoid arthritis treatment modalities, the risk of having moderate-to-high disease activity (DAS28>3.2) was significantly higher in patients with MetS compared with those with no MetS components (OR 9.24, 95% CI 1.49 to 57.2, p = 0.016).

Conclusion: A high, albeit comparable to the control population, prevalence of MetS was found in middle-to-older aged patients with rheumatoid arthritis. The correlation of rheumatoid arthritis disease activity with MetS suggests that the increased prevalence of coronary heart disease in patients with rheumatoid arthritis may, at least in part, be attributed to the inflammatory burden of the disease.

Abbreviations: BMI, body mass index; CHD, coronary heart disease; CVD, cardiovascular disease; DAS28, disease activity score of 28 joints; EGIR, European Group for the Study of Insulin Resistance; ESR, erythrocyte sedimentation rate; HDL-C, high-density lipoprotein cholesterol; hs-CRP, high-sensitivity C reactive protein; LDL-C, low-density lipoprotein cholesterol; MetS, metabolic syndrome; NCEP ATPIII, Adult Treatment Panel III of the National Cholesterol Education Program; TNF, tumour necrosis factor; WHO, World Health Organization

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