Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort

• Authors: S Sam Lim, Emory University; Ben Parker, The University of Manchester; Murray B Urowitz, Toronto Western Hospital and University of Toronto; Dafna D Gladman, Toronto Western Hospital and University of Toronto; Mark Lunt, The University of Manchester; Rachelle Donn, The University of Manchester; Sang-Cheol Bae, Hanyang Univ Hosp Rheumat Dis; Jorge Sanchez-Guerrero, Instituto Nacional de Ciencias Medicas y Nutrición; Juanita Romero-Diaz, Instituto Nacional de Ciencias Medicas y Nutrición; Caroline Gordon, University of Birmingham; Daniel J Wallace, University of California Los Angeles; Ann E Clarke, McGill University; Sasha Bernatsky, McGill University
• Journal Title: Annals of the Rheumatic Diseases
• Volume: Volume 74, Number 8
• Publisher: BMJ Publishing Group | 2015-08-01, Pages 1530-1536
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/annrheumdis-2013-203933
• Subjects: Health Sciences, General; Health Sciences, Immunology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Rheumatology; CORONARY-HEART-DISEASE; TREATMENT PANEL-III; RISK-FACTORS; ACCELERATED ATHEROSCLEROSIS; DIABETES-FEDERATION; WOMEN; CHOLESTEROL; HYDROXYCHLOROQUINE; ASSOCIATION; PREVALENCE

Abstract

Background The metabolic syndrome (MetS) may contribute to the increased cardiovascular risk in systemic lupus erythematosus (SLE). We examined the association between MetS and disease activity, disease phenotype and corticosteroid exposure over time in patients with SLE. Methods Recently diagnosed (>15 months) patients with SLE from 30 centres across 11 countries were enrolled into the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort from 2000 onwards. Baseline and annual assessments recorded clinical, laboratory and therapeutic data. A longitudinal analysis of factors associated with MetS in the first 2 years of follow-up was performed using random effects logistic regression. Results We studied 1150 patients with a mean (SD) age of 34.9 (13.6) years and disease duration at enrolment of 24.2 (18.0) weeks. In those with complete data, MetS prevalence was 38.2% at enrolment, 34.8% at year 1 and 35.4% at year 2. In a multivariable random effects model that included data from all visits, prior MetS status, baseline renal disease, SLICC Damage Index <1, higher disease activity, increasing age and Hispanic or Black African race/ethnicity were independently associated with MetS over the first 2 years of follow-up in the cohort. Conclusions MetS is a persi stent phenotype in a significant proportion of patients with SLE. Renal lupus, active inflammatory disease and damage are SLE-related factors that drive MetS development while antimalarial agents appear to be protective from early in the disease course.