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.


Prevalence and Persistence of Metabolic Syndrome in a Multicentre International Inception Cohort of Patients with SLE.

Urowitz34,  Murray B., Gladman22,  Dafna D., Ibanez33,  Dominique, Bruce13,  Ian N., Gordon30,  Caroline P., Bae6,  Sang-Cheol, Clarke15,  Ann E.

West Hollywood, CA
Kantonsspital Schaffhausen, Schaffhausen, Switzerland
Karolinska University Hospital
Landspitalinn University Hospital
Manchester Royal Infirmary, Manchester, United Kingdom
Medical University of South Carolina, Charleston, SC
Montreal General Hospital, Montreal, QC, Canada
North West Wales NHS Trust, Colwyn Bay, United Kingdom
Northwestern University, Chicago, IL
Oklahoma Med Research Foundation, Oklahoma City, OK
Queen Elizabeth II Health Services Center, Halifax, NS, Canada
Timonium, MD
SUNY-Downstate Medical Center, Brooklyn, NY
The Rayne Institute, London, United Kingdom
Toronto Western Hospital, Toronto, ON, Canada
UAB Rheumatology, Birmingham, AL
UCL Div of Medicine
UCL Div of Medicine, London, United Kingdom
UCSD School of Medicine, La Jolla, CA
Univerity of Toronto Lupus Clinic, Toronto Western Hospital, Toronto, ON, Canada
University Hospital Lund, Lund, Sweden
University of Alabama, Oakland, CA
Emory University, Atlanta, GA
University of Birmingham, Birmingham, United Kingdom
University of Manitoba, Winnipeg, MB, Canada
University of North Carolina at Chapel Hill, Chapel Hill, NC
University of Toronto Lupus Clinic, Toronto Western Hospital
University of Toronto Lupus Clinic, Toronto Western Hospital, Toronto, ON, Canada
West Penn Allegheny Health System, Pittsburgh, PA
Feinstein Institute, Manhasset, NY
Hairmyres Hospital, East Kilbride, United Kingdom
Hanyang University Medical Center, Seoul, Korea, Republic of
Hospital Clinico I Provincial
Hospital de Cruces, Universidad del Pais Vasco
Instituto Nacional Nutricion, Mexico City, DF, Mexico

Background:

Metabolic Syndrome (MetSyn) is likely to be a significant predisposing factor to atherosclerotic vascular disease (ASVD) in Systemic Lupus Erythematosus (SLE). The purpose of this study is to determine the prevalence and persistence over two years of MetSyn in a multicentre, international inception cohort of patients with SLE.

Methods:

An international inception cohort registry has enrolled 1593 recently diagnosed patients with SLE from 30 centres in 11 countries. All patients are assessed according to a standard protocol including clinical and laboratory variables, and SLEDAI-2K and SDI are calculated at enrollment and annual follow-up visits. The International Diabetes Federation definition for MetSyn was used and included the following criteria: increased waist circumference (>= 94 cm for men, >= 80 cm for women) plus any two of raised triglycerides or specific treatment for this lipid abnormality and/or reduced HDL cholesterol or specific treatment for this lipid abnormality and/or raised blood pressure and/or increased fasting plasma glucose or previously diagnosed type II diabetes. A minimum of 2 of the latter 4 must be known for the definition to be valid.

Results:

Of the inception cohort of SLE patients (89F, 48% Caucasian, age at diagnosis 35), 13.6% had MetSyn at baseline (Table 1).

Although the prevalence of MetSyn is approximately 12% at any given time, the cumulative prevalence increases progressively to 25% by year 8. Most of the increased prevalence occurred within the first 3 years.

In total, 644 patients had at least two years of follow-up data available

The incidence of MetSyn over two years was 11.0% and in the subgroup of 88 with MetSyn at enrolment persistence of MetSyn was 17.0% (Table 2).

Conclusion:

MetSyn is present in 13.6% of newly diagnosed patients with SLE and persists in 17% of these patients over two years. Future work will determine the relationship between MetSyn prevalence and persistence with inflammatory disease activity and inflammation biomarkers as well as the effect of steroid exposure and lupus phenotype on the development and persistence of MetSyn.

Table 1. Presence of MetSyn criteria in inception cohort of 1593 patients.

 Present or AbnormalNormal
Metabolic Syndrome195 (13.6%)1238
Waist Circumference649 (47.6%)715
BMI265 (17.4%)1259
Either Waist or BMI700 (45.4%)841
TG374 (28.7%)928
HDL227 (31.4%)495
BP721 (45.9%)851
BS225 (16.9%)1105

Table 2. Presence, incidence and persistence of MetSyn in 644 patients with two years of follow up.

Met Syn At enrolMet Syn at Yr 1Met Syn at Yr 2# Patients 
556 without MetSyn at enrolment
absentabsentabsent495Incidence 61/556 (11.0%)
absentabsentpresent23 
absentpresentabsent26 
absentpresentpresent12 
88 with MetSyn at enrolment   
presentabsentabsent42Persistence 15/88 = 17.0%
presentabsentpresent12 
presentpresentabsent19 
presentpresentpresent15 

To cite this abstract, please use the following information:
Urowitz, Murray B., Gladman, Dafna D., Ibanez, Dominique, Bruce, Ian N., Gordon, Caroline P., Bae, Sang-Cheol, et al; Prevalence and Persistence of Metabolic Syndrome in a Multicentre International Inception Cohort of Patients with SLE. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :476
DOI: 10.1002/art.28245

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