Background Rheumatoid arthritis (RA) is associated with increased morbidity and mortality due to cardiovascular disease. The metabolic syndrome (MetS) may contribute to the excess cardiovascular burden observed in RA. The prevalence of MetS in RA seems to be increased, suggesting that systemic inflammation and anti-rheumatic therapy may contribute to its presence.
Objectives Weaimed to determine the prevalence of MetS in RA, to identify the potential factors associated with its presence, and to evaluate the influence of anti-rheumatic drugs on the occurrence of MetS in Moroccan patients with RA.
Methods The prevalence of MetS was assessed cross-sectionally in 179 patients with RA fulfilling the American College of Rheumatology criteria (ACR 1987) or the ACR / EULAR 2010 criteria (European League Against Rheumatism) over a period of 17 months (July 2011-December 2012). Three definitions of MetS were used: National Cholesterol Education Program / Adult Treatment Panel III 2005, International Diabetes Federation 2005, and American Association of Clinical Endocrinologists 2003. All statistical analyses were done using the SPSS software version 18.0. Multivariate logistic regression model was constructed to identify independent predictors of MetS in patients with RA. Statistical significance was defined as the two tailed P-value < 0.05.
Results The prevalence of MetS rates in RA varied from 24.6% to 30.7% according to the definitions used. Its presence was associated with an older age (p=0,001), a higher activity of the disease (p=0.01), a higher HAQ score (p=0.001), severity of RA (p=0,001), and hyper-uricemia (p=0.002). Other factors like gender, educational level, disease duration of RA, erythrocyte sedimentation rate, C-reactive protein, immunological tests do not appear to be associated with the presence of MetS. An association was found with the use of corticosteroid (p=0.039) at high doses (p=0.037), and also with NSAIDs (p=0,001). The less methotrexate use was associated with the presence of MetS (p=0.017). However, no relationship was found between the use of the other DMARDs and biotherapy, and the MetS. The independence of each of these associations was tested in a multivariate logistic regression model. Severity of RA (OR = 5, 95% CI = [1.96 to 13.16], p = 0.001), NSAIDs use (OR = 2.88, 95 % = [1.1 to 7.48], p = 0.03), and less methotrexate use (OR = 0.32, 95% CI = [0.12-0.86], p = 0.02) remained significant independent predictors of the presence of the MetS in RA patients.
Conclusions Our study suggeststhat MetSis common amongolder patientswith activeand severe RA. Severity of the disease, NSAIDs use and less methotrexate use, were identified as an independent predictors associated with the presence of MetS in patients with RA. These findings suggest that physicians should screen for MetS in older patients with active and severe RA to control its components and therefore reduce their risk of cardiovascular diseases. Consideration should be given to using methotrexate as first-line DMARD therapy in RA patients deemed to be at the highest risk of MetS.
Disclosure of Interest None Declared
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