Metabolic syndrome commonly associated with early rheumatoid arthritis
A Canada-wide multicentre study of patients with early rheumatoid arthritis (ERA) has found an association between metabolic syndrome and rheumatoid arthritis, and that the prevalence is most common among men and postmenopausal women.
September is National Arthritis Awareness Month in Canada. With rheumatoid arthritis, the patient’s joints and organs are “attacked” by their own immune system. This is the most common type of autoimmune arthritis. Persons with the disease typically experience swollen joints, pain and stiffness, and chronic fatigue. In later stages of the disease, incessant inflammation breaks down the joint, causing permanent damage, and can impair nerves and blood vessels. It is important for patients to begin treatment as early as possible.
The Canadian Early Arthritis Cohort (CATCH) study collects data on over 3,000 patients across Canada with ERA. Patients in this cohort are defined as a person who is within one year of symptom onset.
Dr. Lillian Barra, Associate Scientist at Lawson Health Research Institute (Lawson), and Rheumatologist at St. Joseph’s Hospital London, was interested in learning about the association between ERA and other diseases and conditions that are commonly found among patients with ERA. Metabolic syndrome refers to a cluster of conditions that often occur together and increase the risk of heart disease, stroke, and type 2 diabetes. These include heart disease, high blood pressure, abnormal cholesterol, obesity and high blood sugar.
Dr. Barra and her team conducted a cross-sectional examination of CATCH data and found that metabolic syndrome was present in 31 per cent of participants, and more common among men (42%), than women (26%). Metabolic syndrome was more prevalent in postmenopausal women (33%) when compared to premenopausal women (15%). They also found that women with ERA experienced menopause earlier in life.
“It is interesting that we found these conditions of metabolic syndrome so early in the course of this disease. While previous researchers have demonstrated an association, it remains a question whether metabolic syndrome contributes to rheumatoid arthritis, or vice versa.” explains Dr. Barra.
“This information can help inform clinicians managing patients with rheumatoid arthritis. In the future, we hope to develop more precise guidelines around when these comorbidities should be screened for and co-managed over the course of treatment.”
Currently, if a newly diagnosed rheumatoid arthritis patient presents with severe symptoms, they are given therapies that work quickly to reduce the inflammation in addition to long-term disease modifying drugs that are the standard of care. These therapies include corticosteroids, such as prednisone, and non-steroidal anti-inflammatories (NSAIDs), such as Advil or Motrin. For the clinician, it is important to consider if the patient has any conditions of metabolic syndrome, as these fast-acting therapies are known to increase the risk of heart disease and stroke. The treatment approach may be altered if these conditions are present.
Dr. Barra plans to re-examine the CATCH data at a later time, to determine if metabolic syndrome and rheumatoid arthritis worsens or improves over time. In future research, she also hopes to discover some of the causes and mechanisms at play, to better understand why many patients with rheumatoid arthritis also have metabolic syndrome.
Scientist
