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.


The Metabolic Syndrome in Systemic Lupus Erythematosus: More Than the Sum of Its Parts?

Parker3,  Ben, Ahmad4,  Yasmeen, Shelmerdine1,  Joanna, Haque2,  Sahena, Bruce1,  Ian N.

Manchester, United Kingdom
Manchester, United Kingdom
Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, United Kingdom
Manchester Royal Infirmary, Manchester, United Kingdom

Purpose:

The metabolic syndrome (MetS) is a clustering of metabolic abnormalities in individuals with increased adiposity and is associated with an increased risk of developing diabetes and coronary heart disease (CHD). The prevalence of the MetS is increased in SLE although rates of obesity are not. Therefore lupus-specific factors and inflammatory disease may be an important contributor to the metabolic derangements observed in those SLE patients with the MetS. The aim of this study is to determine those disease characteristics associated with the presence of the MetS and to investigate whether the MetS is associated with the presence of carotid plaque in patients with SLE.

Methods:

Caucasian women with SLE were assessed in a cross-sectional observational study. Disease activity (SLEDAI), disease damage (SLICC-DI) and clinical characteristics were determined. The MetS was defined according to the 2009 Consensus Statement from the IDF and partners. All patients underwent B-mode ultrasound of the common carotid and proximal internal and external carotid arteries to detect plaque. Mutivariate logistic regression was performed to determine the association between disease characteristics and the MetS, and the presence of carotid plaque and the MetS.

Results:

200 women with SLE were assessed of whom 30% fulfilled the criteria for the MetS. Those meeting the MetS definition were older (median (IQR) age 53 (46, 59) years vs. 46.5 (41, 53) years, p = 0.001) and had a longer disease duration (median (IQR) 14 (6–22) years vs. 7 (4–16) years, p = 0.002) than those who did not. In a multivariate model the presence of the MetS was associated with age, disease duration and low C3 but not with average steroid dose.

Table 1. Lupus Features associated with the MetS

VariableAge-Adjusted OR (95% CI)
Low C38.46 (1.25, 57.0))
Age1.06 (1.01, 1.10)
Disease duration1.05 (1.01, 1.09)
Steroids Ever2.46 (0.69, 8.72)
Azathioprine Ever2.06 (0.89, 4.75)
SLICC1.35 (0.99, 1.85)
Renal Disease Ever1.89 (0.63, 5.66)
Average Steroid Dose (6 months)1.03 (0.97, 1.11)

Carotid plaque was present in 42% of SLE patients with the MetS compared to 23.5 % of patients without (p = 0.01). Overall, the MetS was not independently associated with the presence of carotid plaque (OR 1.7 (95% CI 0.8, 3.4). However, fulfilling IDF criteria for high blood pressure and hypertriglyceridaemia (OR 2.9 (1.3, 6.3) and 2.2 (1.1, 4.4) respectively) were both associated with the presence of carotid plaque.

Conclusions:

The MetS is more prevalent with increasing age in SLE. Low complement and disease duration were independently associated with the presence of the MetS in SLE suggesting a role for inflammatory activity in contributing to the syndrome. The MetS was not associated with the presence of carotid plaque overall, although individual criteria were. Therefore a CHD risk assessment strategy attending to these individual risk factors would appear a more important way to modify CHD risk in patients with SLE.

To cite this abstract, please use the following information:
Parker, Ben, Ahmad, Yasmeen, Shelmerdine, Joanna, Haque, Sahena, Bruce, Ian N.; The Metabolic Syndrome in Systemic Lupus Erythematosus: More Than the Sum of Its Parts? [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1177
DOI: 10.1002/art.28943

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