Prevalence, incidence and characteristics of the metabolic syndrome (MetS) in a cohort of Mexican Mestizo early rheumatoid arthritis patients treated with conventional disease modifying anti-rheumatic drugs: the complex relationship between MetS and disease activity

Federico Parra-Salcedo, Irazú Contreras-Yáñez, Daniel Elías-López, Carlos A Aguilar-Salinas, Virginia Pascual-Ramos, Federico Parra-Salcedo, Irazú Contreras-Yáñez, Daniel Elías-López, Carlos A Aguilar-Salinas, Virginia Pascual-Ramos

Abstract

Introduction: A higher prevalence of metabolic syndrome (MetS) has been described in rheumatoid arthritis (RA), along with an association with disease activity. Objectives were to describe prevalence of MetS at RA diagnosis in a cohort of Mexican Mestizo early RA patients, and to define a causal association between MetS and disease activity.

Methods: The study population was a prospective cohort. At baseline and at fixed 6-months-intervals, patients had medical evaluations, fasting serum glucose, triglycerides, high-density lipoprotein cholesterol and acute reactant-phase determinations. MetS was defined according to international criteria and body mass index (BMI)≥30 kg/m2 was used as a surrogate of the waist circumference. The study was approved by the internal review board. Appropriated statistics and Cox regression analysis were used. All statistical tests were two-sided and evaluated at the 0.05 significance level.

Results: Up to March 2014, data from 160 patients were analyzed. At baseline, they were more frequently middle-aged females and had moderate to high disease activity. Prevalence of MetS varied from 11.3% to 17.5% in patients and was lower to that from matched controls (versus 26.3% to 30%, P≤0.01). Up to last follow-up, 39 patients (34.5%) developed incidental MetS. In the Cox regression analysis, cumulative disease activity score (DAS) 28 (odds ratio (OR): 1.81, 95% confidence interval (CI): 1.346 to 2.433, P=0.000) and baseline BMI (OR: 1.13, 96% CI: 1.035 to 1.236, P=0.007) were the only predictors for incidental MetS. RA patients with incidental MetS accumulated more disease activity and had less frequent remission than their counterparts. Logistic regression analysis showed that incidental MetS (OR: 0.2, 95% CI: 0.01 to 0.99, P=0.052) and baseline DAS28 (OR: 0.4, 95% CI: 0.2 to 0.9, P=0.02) were the only predictors for achieving or maintaining sustained (≥6 months) remission.

Conclusions: MetS prevalence in a cohort of early RA patients was lower than that from matched controls. Cumulative disease activity and higher BMI were risk factors for incidental Mets; higher baseline disease activity and incidental MetS prevented sustained remission. In addition to disease activity, MetS needs to be controlled to impact disease outcomes.

Figures

Figure 1
Figure 1
Comparison of prevalence of metabolic syndrome between rheumatoid arthritis patients and matched controls. Numbers inside bars represent the number of patients and controls with metabolic syndrome according to the three different definitions. AHA/NHLBI, American Heart Association/National Heart, Lung and Blood Institute; IDF, International Diabetes Federation; NCEPT/ATPIII, National Cholesterol Education Program Adult Treatment Panel III; RA, rheumatoid arthritis.
Figure 2
Figure 2
Annual metabolic syndrome incidence rate. MetS, metabolic syndrome.
Figure 3
Figure 3
Comparison of disease activity-related outcomes after the index date between cases and controls. Comparison of disease activity-related outcomes after the index date, between rheumatoid arthritis (RA) patients with incidental metabolic syndrome (Mets; cases) and their matched controls (RA patients who did not develop incidental MetS up to last follow-up). (A) Median (range) cumulative disease activity score evaluated in 28 joints after the index date in RA patients who developed incidental MetS and their controls. (B) Distribution (n (%)) of patients and controls who achieved or maintained remission and of patients and controls with disease flare or who never achieved remission, from the index date up to last follow-up.

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