Limits...
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.

Parra-Salcedo F, Contreras-Yáñez I, Elías-López D, Aguilar-Salinas CA, Pascual-Ramos V - Arthritis Res. Ther. (2015)

Bottom Line: Appropriated statistics and Cox regression analysis were used.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México. fepa_an@hotmail.com.

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.

No MeSH data available.


Related in: MedlinePlus

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4362822&req=5

Fig3: 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.

Mentions: We then explored the impact of MetS on disease activity. A case–control study nested within a cohort was designed; among the 39 RA patients with incidental MetS, 30 were paired to 30 corresponding matched controls (age, gender, index date, menopause status, RF, ACCP and follow-up). Cumulative outcomes related to disease activity were compared between RA cases and controls after the index date and results are summarized in Figure 3A,B. RA patients with incidental MetS had higher median (range) cumulative DAS28 after the index date than RA patients who never developed MetS over follow-up (Figure 3A); also, less RA patients from the former group achieved or maintained remission while more patients had disease flare or never achieved remission when compared with the control group (Figure 3B). We then compared characteristics from patients who achieved or maintain remission after the index date (n = 46) and those who never achieved remission (n = 14); as shown in Table 6, the former had lower BMI, longer disease duration at baseline evaluation, lower baseline disease activity (as per DAS28, ESR and CRP) and disability, developed incidental MetS less frequently and were more frequently obese at the baseline evaluation. Baseline (not shown) and cumulative treatment before sustained remission was similar (corticosteroid use and number of DMARDs/patient). Finally, logistic regression analysis was performed in order to identify predictors for remission after incident MetS. Table 7 presents the different models tested; in all of them, incidental MetS and baseline DAS28 were the only predictors for achieving or maintaining a sustained remission status.Figure 3


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.

Parra-Salcedo F, Contreras-Yáñez I, Elías-López D, Aguilar-Salinas CA, Pascual-Ramos V - Arthritis Res. Ther. (2015)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4362822&req=5

Fig3: 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.
Mentions: We then explored the impact of MetS on disease activity. A case–control study nested within a cohort was designed; among the 39 RA patients with incidental MetS, 30 were paired to 30 corresponding matched controls (age, gender, index date, menopause status, RF, ACCP and follow-up). Cumulative outcomes related to disease activity were compared between RA cases and controls after the index date and results are summarized in Figure 3A,B. RA patients with incidental MetS had higher median (range) cumulative DAS28 after the index date than RA patients who never developed MetS over follow-up (Figure 3A); also, less RA patients from the former group achieved or maintained remission while more patients had disease flare or never achieved remission when compared with the control group (Figure 3B). We then compared characteristics from patients who achieved or maintain remission after the index date (n = 46) and those who never achieved remission (n = 14); as shown in Table 6, the former had lower BMI, longer disease duration at baseline evaluation, lower baseline disease activity (as per DAS28, ESR and CRP) and disability, developed incidental MetS less frequently and were more frequently obese at the baseline evaluation. Baseline (not shown) and cumulative treatment before sustained remission was similar (corticosteroid use and number of DMARDs/patient). Finally, logistic regression analysis was performed in order to identify predictors for remission after incident MetS. Table 7 presents the different models tested; in all of them, incidental MetS and baseline DAS28 were the only predictors for achieving or maintaining a sustained remission status.Figure 3

Bottom Line: Appropriated statistics and Cox regression analysis were used.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México. fepa_an@hotmail.com.

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.

No MeSH data available.


Related in: MedlinePlus