By Dr Irwin Lim, Rheumatologist
At the recent EULAR conference, I wasn't able to attend as many sessions as I would have liked due to the sessions running concurrently. One such session was on the Metabolic syndrome (MetS).
MetS is a disorder with components that include central obesity, elevated fasting glucose, hypertension, and/or dyslipidemia (see definition). This combination significantly increases the risk of major cardiovascular disease.
The very helpful EULAR app I reviewed (read review) contains the abstracts for that session so I read those & tried to summarize the take-home messages.
THE METABOLIC SYNDROME IN SLE (abstract SP0185 I. Bruce, Manchester, UK)
Cardiovascular (CVS) disease is excessive in SLE, leading to increased death and impaired function. This continues to be a problem almost 40 years after its first description.
A significant part of this is likely to be due to MetS being more common in patients with SLE. The high use of corticosteroid therapy in SLE contributes to this as does having active inflammatory disease.
Certain ethnic backgrounds seem particularly prone to MetS, most notably patients from Korean and Hispanic backgrounds.
Close attention to traditional CVS risk factors and the MetS should be a cornerstone of management. Disease should be suppressed as much as possible whilst using the lowest possible dose of steroid therapy. Patients should be treated with anti-malarial agents whenever possible.
THE METABOLIC SYNDROME: THE CROSSROAD BETWEEN RHEUMATOID ARTHRITIS (RA) & THE CARDIOVASCULAR RISK (abstract SP0186 G. Ferraccioli, Rome, Italy)
An analysis was performed on three cohorts of patients:
564 RA (346 with early RA & 218 with long standing RA with severe disease requiring biologic treatment),
452 SLE patients
296 SSc patients
This showed a high prevalence of MetS, 14% for SSc, 25-27% in the RA groups and 31% for SLE. Obesity was found in 10-13% of all patients.
The data for the RA patients was then presented. In early RA, MetS at baseline was not shown to influence the outcome but in those with long-standing RA, MetS led to a significantly lower change of achieving a good result with disease control.
In early RA, obesity did lead to significantly lower rates of remission (DAS or CDAI criteria) when the patients were followed up 12 months later. A higher percentage of obese and overweight early RA patients required anti-TNF treatment after 12 months of follow-up (28.1% of obese, 28.8% of overweight, 16.2% of normal weight).
In long-standing RA the predictors of not obtaining a good response at the 12th month of anti-TNF therapy included the presence of hyperglycemia and hypertension at baseline.
METABOLIC SYNDROME IN PATIENTS WITH PSORIATIC DISEASE (abstract SP0187 A.Ogdie, Philadelphia, USA)
Higher levels of MetS are seen in Psoriasis & Psoriatic Arthritis patients compared to the general population. It's thought that this MetS partially explains the increased risk of CVS disease reported in patients with psoriatic disease.
Both psoriasis and obesity share increased levels of inflammatory cytokines which may promote insulin resistance, dyslipidemia and atherosclerosis.
INCIDENCE OF SEVERE KNEE & HIP OSTEOARTHRITIS (OA) IN RELATION TO THE METABOLIC SYNDROME & ITS COMPONENTS: A PROSPECTIVE COHORT STUDY (Abstract OP0311 S. M. Hussain et al, various institutions in Melbourne & Adelaide, Australia)
21,837 participants who had fasting blood lipids, anthropometric & blood pressure measurements during 2003-2007 were selected from the Melbourne Collaborative Cohort Study.
Of these, 685 participants who had severe knee OA & 580 who had severe hip OA requiring total joint replacement were identified.
Central obesity and hypertension were associated with increased risk of knee OA. Interestingly, the higher the number of components of the MetS, the higher the knee OA risk. Of note, this was independent of BMI.
No significant associations were observed for severe hip OA.
The findings suggest different causes of knee & hip OA. Management of MetS may reduce the risk of knee OA.
http://www.freedigitalphotos.netMetS is relevant to our patients. We rheumatologists discuss drug therapy readily but we do also need to become better at helping patients address this syndrome.
I think this emphasises the need for coordinated, multidisciplinary care such as BJC Health's Connected Care approach. Our dietitians & exercise physiologists are essential allies.
What do you think?
Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.