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Extended report
Clinical associations of the metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort
  1. Ben Parker1,
  2. Murray B Urowitz2,
  3. Dafna D Gladman2,
  4. Mark Lunt1,3,
  5. Sang-Cheol Bae4,
  6. Jorge Sanchez-Guerrero5,
  7. Juanita Romero-Diaz5,
  8. Caroline Gordon6,
  9. Daniel J Wallace7,
  10. Ann E Clarke8,
  11. Sasha Bernatsky8,
  12. Ellen M Ginzler9,
  13. David A Isenberg10,
  14. Anisur Rahman10,
  15. Joan T Merrill11,
  16. Graciela S Alarcón12,
  17. Barri J Fessler12,
  18. Paul R Fortin13,
  19. John G Hanly14,15,
  20. Michelle Petri16,
  21. Kristjan Steinsson17,
  22. Mary-Anne Dooley18,
  23. Susan Manzi19,
  24. Munther A Khamashta20,
  25. Rosalind Ramsey-Goldman21,
  26. Asad A Zoma22,
  27. Gunnar K Sturfelt23,
  28. Ola Nived23,
  29. Cynthia Aranow24,
  30. Meggan Mackay24,
  31. Manuel Ramos-Casals25,
  32. Raymond F van Vollenhoven26,
  33. Kenneth C Kalunian27,
  34. Guillermo Ruiz-Irastorza28,
  35. Sam Lim29,
  36. Diane L Kamen30,
  37. Christine A Peschken31,
  38. Murat Inanc32,
  39. Ian N Bruce1,3
  1. 1Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
  2. 2Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
  3. 3NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
  4. 4Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
  5. 5Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico
  6. 6Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  7. 7Department of Rheumatology, Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  8. 8Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
  9. 9Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA
  10. 10Centre for Rheumatology Research, University College London, London, UK
  11. 11Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
  12. 12Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  13. 13Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada
  14. 14Division of Rheumatology, Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
  15. 15Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
  16. 16Department of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
  17. 17Center for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland
  18. 18University of North Carolina, Chapel Hill, North Carolina, USA
  19. 19Department of Medicine, West Penn Allegheny, Pittsburgh, Pennsylvania, USA
  20. 20Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King's College London School of Medicine, London, UK
  21. 21Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA
  22. 22Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK
  23. 23Department of Rheumatology, University Hospital Lund, Lund, Sweden
  24. 24Center for Autoimmune and Musculoskeletal, Feinstein Institute for Medical Research, Manhasset, New York, USA
  25. 25Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
  26. 26Department of Rheumatology, Karolinska Institute, Stockholm, Sweden
  27. 27UCSD School of Medicine, La Jolla, California, USA
  28. 28Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
  29. 29School of Medicine, Emory University, Atlanta, Georgia, USA
  30. 30Medical University of South Carolina, Charleston, South Carolina, USA
  31. 31Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  32. 32Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
  1. Correspondence to Professor Ian N Bruce, Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester M13 9PT, UK; ian.bruce{at}


Background The metabolic syndrome (MetS) may contribute to increased cardiovascular risk in systemic lupus erythematosus (SLE). We aimed to examine the association of demographic factors, lupus phenotype and therapy exposure with the presence of MetS.

Methods The Systemic Lupus International Collaborating Clinics Registry for Atherosclerosis inception cohort enrolled recently diagnosed (<15 months) SLE patients from 30 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected according to a standardised protocol. MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Univariate and backward stepwise multivariate logistic regression were used to assess the relationship of individual variables with MetS.

Results We studied 1686 patients, of whom 1494 (86.6%) had sufficient data to determine their MetS status. The mean (SD) age at enrolment and disease duration was 35.2 years (13.4) and 24.1 weeks (18.0), respectively. MetS was present at the enrolment visit in 239 (16%). In backward stepwise multivariable regression analysis, higher daily average prednisolone dose (mg) (OR 1.02, 95% CI 1.00 to 1.03), older age (years) (OR 1.04, 95% CI 1.03 to 1.06), Korean (OR 6.33, 95% CI 3.68 to 10.86) and Hispanic (OR 6.2, 95% CI 3.78 to 10.12) ethnicity, current renal disease (OR 1.79, 95% CI 1.14 to 2.80) and immunosuppressant use (OR 1.81, 95% CI 1.18 to 2.78) were associated with MetS.

Conclusions Renal lupus, higher corticosteroid doses, Korean and Hispanic ethnicity are associated with MetS in SLE patients. Balancing disease control and minimising corticosteroid exposure should therefore be at the forefront of personalised treatment decisions in SLE patients.

  • Systemic Lupus Erythematosus
  • Cardiovascular Disease
  • Inflammation
  • Epidemiology

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    BMJ Publishing Group Ltd and European League Against Rheumatism