Rheumatoid Arthritis and Metabolic Syndrome: High Prevalence and Risk

Researchers found high prevalence and risk for metabolic syndrome (MetS) in patients with rheumatoid arthritis (RA) and recommended these patients undergo evaluation for measuring the cluster of conditions, according to a recent meta-analysis published in PLoS ONE.

Jamal Hallajzadeh, PhD, from the Managerial Epidemiology Research Center, Department of Public Health, Maragheh University of Medical Sciences, Iran, and colleagues searched the PubMed, Embase, Scopus, Web of Science, CINAHL, and other international databases for prevalence and risk for MetS in patients with RA. The researchers identified 70 studies analyzing prevalence of MetS (n=12,612) and 43 studies identifying risk for MetS (n=35,220) published between January 2000 and August 2016. 

The studies included risk and prevalence of MetS, as well as its components, including blood pressure, waist circumference, triglycerides, fasting blood sugar, and high-density lipoprotein cholesterol.

The pooled prevalence of MetS was 30.65% (95% CI, 27.87%-33.43%), which varied between 14.32% (95% CI, 10.59%-18.05%) and 37.83% (95% CI, 31.05%-44.61%), depending on the MetS criteria used, such as World Health Organization, National Cholesterol Education Programme Adult Treatment Panel III, International Diabetes Federation, Association of Clinical Endocrinologists, or American Heart Association/National Heart, Lung, and Blood Institute criteria. 

Compared with healthy control patients, there was a positive association between RA and MetS (OR, 1.44; 95% CI, 1.20-1.74) with a range of 0.70 (95% CI, 0.27-1.76) and 4.09 (95% CI, 2.03-8.25), depending on the MetS criteria used.

The investigators noted that the variance in prevalence of MetS among different studies may be a result of different criteria definitions used within the cluster of conditions, lack of consistency in the number of components within the definitions, and “different and multiple phenotypes included in each definition of MetS.”

“However, prevalence rates also vary widely even when comparing studies that have used the same criteria,” Dr Hallajzadeh and colleagues wrote. 

“Therefore, it is likely that other factors related to the characteristics of the study population, such as: genetic, ethnic, cultural, demographic, socioeconomic and clinical factors, also affect the prevalence. Thus, studies conducted using different populations are critical in order to identify other factors related to MetS.”

By sex, there was a higher, nonstatistically significant prevalence of MetS in female patients with RA (33.03%; 95% CI, 28.09%-37.97%) compared with male patients with RA (31.94%; 95% CI, 24.37%-39.51%).

Summary & Clinical Applicability

“According to the high prevalence of MetS in RA patients and the high risk of it, monitoring and testing for metabolic syndrome in these patients is clearly recommended,” Dr Hallajzadeh and colleagues wrote in their study. “As the most important component of metabolic syndrome was found to be a high [waist circumference], it is clearly important to pay more attention to patient nutrition and weight loss.”

Limitations & Disclosures

• The researchers noted their results could not be expanded to include all other countries because of lack of information, and data were presented in crude, unadjusted odds ratios because of the nature of different cofounders in the studies included in the analysis.

Reference

Hallajzadeh J, Safiri S, Mansournia MA, et al. Metabolic syndrome and its components among rheumatoid arthritis patients: a comprehensive updated systematic review and meta-analysis [published online March 23, 2017]. PLoS One. doi:10.1371/journal.pone.0170361

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