Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Antimalarials May Attenuate the Risk of Metabolic Syndrome in SLE: Results from an International Imception Cohort Registry.

Ting2,  M. H. X., Donn3,  R. P., Lunt3,  M., Urowitz4,  M. B., Gladman1,  D. D., Ibanez1,  D., Gordon1,  C.

Systemic Lupus International Collaborating Clinics, Toronto, ON, Canada
The University of Manchester, Salford, Manchester, United Kingdom
The University of Manchester
Toronto Western Hospital, Toronto, ON, Canada

Background:

The excess cardiovascular mortality in Systemic Lupus Erythematosus (SLE) is not completely accounted for by traditional risk factors. High waist circumference, high triglycerides, low HDL-cholesterol and impaired glucose homeostasis, the clustering of which constitutes the Metabolic Syndrome (MetS), may be implicated. Therapy related factors such as antimalarials and steroids, used widely in the management of SLE, may moderate these risks. We aimed to describe the baseline incidence of the MetS and its association with steroid and antimalarial use in an international prospective SLE cohort.

Method:

Data was obtained from the SLE International Collaborating Clinics-Registry for Atherosclerosis (SLICC-RAS) cohort, collated from 30 centres worldwide. Information on 596 subjects, diagnosed with SLE within 1 year (baseline), was available. The International Diabetes Federation criteria was used to define the MetS, which included the presence of a high waist circumference plus two or more of elevated triglycerides or on specific therapy; reduced HDL-cholesterol or on specific therapy; raised blood pressure(BP) and raised fasting plasma glucose or known Type II diabetes mellitus.

Results:

Of the 596 patients studied, 94 (15.8%) had MetS at their baseline visit. There was a significant difference in prevalence of MetS according to therapy with the highest prevalence being in the group taking steroids alone (P< 0.014) (Table). Similarly, the incidence of high triglycerides and glucose intolerance was also highest in the group on steroids alone (P<0.00003 and P=0.010 respectively). Compared to the steroid monotherapy group, the group on a combination of steroids and antimalarials were significantly less likely to fulfil the criteria for MetS (P=0.002), high BP (P=0.005) and high triglycerides (P<0.0002).

Conclusion:

In this early SLE cohort, steroid monotherapy was associated with the highest prevalence of MetS. The prevalence of MetS, increased blood pressure, increased triglycerides and glucose intolerance were all significantly lower with concomitant use of antimalarials. In addition to their anti-inflammatory effects, antimalarials likely have direct effects on vascular function and lipid metabolism that improves the overall metabolic and cardiovascular risk status of SLE patients.

 Steroids alone (n = 160)Antimalarials alone (n = 130)Steroids and antimalarials (n = 253)Neither steroids or antimalarials (n = 53)P
Metabolic Syndrome38 (23.8%)18 (13.9%)31 (12.3%)7 (13.2%)0.014
High waist circumference69 (43.1%)62 (47.7%)106 (41.9%)20 (27.7%)0.639
High triglycerides or on specific therapy77 (48.1%)30 (23.1%)75 (29.6%)15 (28.3%)0.00003
Low HDL-cholesterol or on specific therapy32 (20%)28 (21.5%)54 (21.3%)11 (20.8%)0.985
High blood pressure67 (41.9%)35 (27.1%)72 (28.5%)17 (32.1%)0.253
Raised fasting plasma glucose or Type 2 diabetes40 (25%)14 (10.8%)55 (21.7%)7 (13.2%)0.010

To cite this abstract, please use the following information:
Ting, M. H. X., Donn, R. P., Lunt, M., Urowitz, M. B., Gladman, D. D., Ibanez, D., et al; Antimalarials May Attenuate the Risk of Metabolic Syndrome in SLE: Results from an International Imception Cohort Registry. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :445
DOI: 10.1002/art.28214

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