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Extended report
Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort
  1. Ben Parker1,2,
  2. Murray B Urowitz3,
  3. Dafna D Gladman3,
  4. Mark Lunt1,2,
  5. Rachelle Donn1,
  6. Sang-Cheol Bae4,
  7. Jorge Sanchez-Guerrero5,
  8. Juanita Romero-Diaz5,
  9. Caroline Gordon6,
  10. Daniel J Wallace7,
  11. Ann E Clarke8,
  12. Sasha Bernatsky8,
  13. Ellen M Ginzler9,
  14. David A Isenberg10,
  15. Anisur Rahman10,
  16. Joan T Merrill11,
  17. Graciela S Alarcón12,
  18. Barri J Fessler12,
  19. Paul R Fortin13,
  20. John G Hanly14,
  21. Michelle Petri15,
  22. Kristjan Steinsson16,
  23. Mary Anne Dooley17,
  24. Susan Manzi18,
  25. Munther A Khamashta19,
  26. Rosalind Ramsey-Goldman20,
  27. Asad A Zoma21,
  28. Gunnar K Sturfelt22,
  29. Ola Nived22,
  30. Cynthia Aranow23,
  31. Meggan Mackay23,
  32. Manuel Ramos-Casals24,
  33. Ronald F van Vollenhoven25,
  34. Kenneth C Kalunian26,
  35. Guillermo Ruiz-Irastorza27,
  36. S Sam Lim28,
  37. Diane L Kamen29,
  38. Christine A Peschken30,
  39. Murat Inanc31,
  40. Ian N Bruce1,2
  1. 1Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
  2. 2NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Toronto, Ontario, Canada
  3. 3Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
  5. 5Instituto 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. 7Cedars-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, UK
  11. 11Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
  12. 12Division of Clinical Immunology and Rheumatology, Department 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 and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
  15. 15Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  16. 16Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland
  17. 17Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
  18. 18 Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
  19. 19Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King's College London School of Medicine, London, UK
  20. 20Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA
  21. 21Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK
  22. 22Department of Rheumatology, University Hospital Lund, Lund, Sweden
  23. 23Feinstein Institute for Medical Research, Manhasset, New York, USA
  24. 24Department of Autoimmune Diseases, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Hospital Clínic, Barcelona, Spain
  25. 25Unit for Clinical Therapy Research (ClinTRID), The Karolinska Institute, Stockholm, Sweden
  26. 26UCSD School of Medicine, La Jolla, California, USA
  27. 27Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
  28. 28Emory University, Atlanta, Georgia, USA
  29. 29Medical University of South Carolina, Charleston, South Carolina, USA
  30. 30University of Manitoba, Winnipeg, Manitoba, Canada
  31. 31Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
  1. Correspondence to Professor Ian N Bruce, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, 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 the increased cardiovascular risk in systemic lupus erythematosus (SLE). We examined the association between MetS and disease activity, disease phenotype and corticosteroid exposure over time in patients with SLE.

Methods Recently diagnosed (<15 months) patients with SLE from 30 centres across 11 countries were enrolled into the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort from 2000 onwards. Baseline and annual assessments recorded clinical, laboratory and therapeutic data. A longitudinal analysis of factors associated with MetS in the first 2 years of follow-up was performed using random effects logistic regression.

Results We studied 1150 patients with a mean (SD) age of 34.9 (13.6) years and disease duration at enrolment of 24.2 (18.0) weeks. In those with complete data, MetS prevalence was 38.2% at enrolment, 34.8% at year 1 and 35.4% at year 2. In a multivariable random effects model that included data from all visits, prior MetS status, baseline renal disease, SLICC Damage Index >1, higher disease activity, increasing age and Hispanic or Black African race/ethnicity were independently associated with MetS over the first 2 years of follow-up in the cohort.

Conclusions MetS is a persistent phenotype in a significant proportion of patients with SLE. Renal lupus, active inflammatory disease and damage are SLE-related factors that drive MetS development while antimalarial agents appear to be protective from early in the disease course.

  • Systemic Lupus Erythematosus
  • Cardiovascular Disease
  • Inflammation

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