Article Text

Extended report
The metabolic syndrome is amplified in hypothyroid rheumatoid arthritis patients: a cross-sectional study
  1. H G Raterman1,
  2. I C van Eijk2,
  3. A E Voskuyl1,
  4. M J L Peters1,
  5. B A C Dijkmans1,2,
  6. V P van Halm1,
  7. S Simsek3,
  8. W F Lems1,
  9. M T Nurmohamed1,2,3
  1. 1
    Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
  2. 2
    Department of Rheumatology, Jan van Breemen Institute, Amsterdam, The Netherlands
  3. 3
    Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr M T Nurmohamed, VU University Medical Centre, Departments of Internal Medicine and Rheumatology, PO Box 7057, 1007 MB Amsterdam, The Netherlands; m.nurmohamed{at}


Objectives: Rheumatoid arthritis (RA) patients are at increased risk of cardiovascular disease (CVD), which is even more pronounced in hypothyroid RA patients. An unfavourable cardiovascular risk profile conferred by a higher prevalence of the metabolic syndrome (MetS) and a higher Framingham risk score might explain this amplified cardiovascular morbidity. This study compared first, MetS (features) and second, the Framingham 10-year CVD risk in RA patients with hypothyroidism compared with euthyroid RA patients.

Methods: RA patients participating in the CARRÉ investigation were divided into two groups: hypothyroid and euthyroid RA patients. MetS according to the National Cholesterol Education Program Third Adult Treatment Panel criteria and the Framingham risk score was compared between hypothyroid and non-hypothyroid CVD event-free RA patients.

Results: In total, 257 RA patients were included: 236 with RA (91.8%) and 21 with hypothyroid RA (8.2%), respectively. The prevalence of the MetS was significantly higher in hypothyroid RA patients (43%) compared with RA patients (20%). Moreover, female hypothyroid RA patients had a higher Framingham risk score compared with euthyroid RA patients. With RA patients as the reference category, the age and gender-adjusted prevalence odds ratio for the MetS was 3.5 (95% CI 1.3 to 9.1) in hypothyroid RA.

Conclusions: Hypothyroid RA patients, particularly female patients, have a more unfavourable cardiovascular risk profile, reflected by an increased prevalence of the MetS and higher Framingham score, than euthyroid RA patients, suggesting a greater need for cardiovascular risk management in these patients to prevent future CVD events.

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  • HGR and ICvE contributed equally to the article.

  • Competing interests None.

  • Ethics approval The Jan van Breemen Institute received approval for this study from the local medical ethics committee.

  • Patient consent Obtained.

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