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.


Favorable Changes in the Lipid Profile in the First Year of Early Arthritis.

Britsemmer1,  Karin, van Schaardenburg1,  Dirkjan, Lems2,  Willem F., Nurmohamed1,  Michael T.

Jan van Breemen Institute Amsterdam
VU University Medical Center Amsterdam

Background:

Several studies provided evidence for excess cardiovascular (CV) morbidity and mortality in rheumatoid arthritis (RA). The inflammatory process and traditional CV risk factors, e.g. dyslipidemia, are considered as the two major contributors to this excess CV disease. Recent studies suggested that abnormal levels of apolipoprotein A (ApoA-I) and apolipoprotein B (ApoB), and particularly the ApoB/ApoA ratio, is at least comparable with the total cholesterol:HDL-cholesterol ratio as predictor of CV morbidity. In this study we investigated the conventional lipid profile and levels of ApoA-I and ApoB in untreated patients with early arthritis and the effect of anti-rheumatic treatment on these levels after six and 12 months.

Methods:

Patients from the Amsterdam Early Arthritis Cohort (EAC) with a disease duration of <2 years, at least 2 swollen joint and no prior DMARD treatment were studied. Patients with osteoarthritis, crystal arthropathy, connective tissue diseases and infectious arthritis were excluded. Lipid levels, inflammation markers and disease activity score (DAS28) were evaluated at baseline and after six and 12 months.

Summary of Results:

The study population comprised 155 patients (mean age 53 [14], 72% female, median symptom duration 1.8 [IQR 1.1–3.7] months, median swollen and tender joint count 5 [3–10] and 7 [5–10], respectively, mean DAS-28 4.9 [1.4]). DMARDs were prescribed in 100% and 96% at 6 and 12 months, respectively. Biologic treatment was given in 2% and 32% at 6 and 12 months, respectively. Table 1 summarizes the mean lipid levels, disease activity markers and acute phase reactants at baseline and after 6 and 12 months. Total cholesterol, ApoA-I levels, LDL- and HDL-cholesterol increased significantly after 6 and 12 months of treatment. Since the changes were larger in HDL cholesterol and ApoA-I, this resulted in a decreased and more favorable total cholesterol:HDL ratio and ApoB:ApoA-I ratio. During the 12 months follow-up decreasing levels of CRP and DAS-28 were significantly associated with increasing levels of total cholesterol, ApoA-I and HDL-cholesterol and decreasing total cholesterol:HDL ratio and ApoB:ApoA-I ratio's.

Table 1. Lipid profile of 155 patients at baseline and after 6 and 12 months

 Baseline6 months (n=89)*12 months (n=45)**
Disease activity markers
CRP, mg/L8 (IQR 2–20)2 (IQR 1–5)2 (IQR 1–4.5)
DAS-284.9 ± 1.42.7 ± 1.22.9 ± 1.2
Lipid levels
Total cholesterol, mmoles/L5.07 ± 1.065.56 ± 1.075.59 ± 1.09
Apo A-I, gm/L1.53 ± 0.311.70 ± 0.311.65 ± 0.32
Apo B, gm/L0.84 ± 0.220.84 ± 0.210.82 ± 0.20
LDL, mmoles/L3.06 ± 0.913.30 ± 0.933.35 ± 0.94
HDL, mmoles/L1.27 (IQR 1.05–1.63)1.49 (IQR 1.29–1.85)1.57 ± 0.39
Total Cholesterol: HDL ratio4.02 ± 1.323.66 ± 1.033.72 ± 0.97
Apo B:Apo A-I ratio0.55 ± 0.170.50 ± 0.150.51 ± 0.16
* p<0.007 except for Apo B** p < 0.03

Conclusion:

This is one of the first studies demonstrating that patients with early arthritis have favorable changes in the lipid profile after six and 12 months of treatment that ultimately may lower their CV risk. These changes in lipid profile, including the total cholesterol:HDL and ApoB:ApoA-I ratio, are significantly associated with decreasing levels of CRP and DAS-28.

To cite this abstract, please use the following information:
Britsemmer, Karin, van Schaardenburg, Dirkjan, Lems, Willem F., Nurmohamed, Michael T.; Favorable Changes in the Lipid Profile in the First Year of Early Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1033
DOI: 10.1002/art.28800

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