Background/Purpose: In a cohort of early (<6 month duration) treatment-naïve rheumatoid arthritis (ERA) patients (the OPERA-study (1)) to measure lipid levels at baseline, year one and two. Further, to analyze for changes in lipid levels in relation to effective DMARD treatment during two years. 

Methods: In 180 ERA patients total s-cholesterol, s-HDL, s-LDL, s-VLDL, s-triglyceride were measured by standardized techniques. All patients were treated with methotrexate (MTX) (20 mg/week) and triamcinolone intraarticularly in any swollen joint for 2 years and in addition randomized to receive adalimumab (ADA) or placebo (PLA) ) during the first year. After year 1, ADA and PLA were withdrawn. If patients had DAS28 (CRP) > 3.2 during year 2, sulphasalazine (SZS) and hydroxychloroquine (HCQ) were added to MTX and if active disease persisted after withdrawel of ADA/PLA, ADA replaced SZS and HCQ in both treatment arms (1). Analysis was by ITT with last observation carried forward. Comparisons by Wilcoxon’s test.

Results: Baseline characteristics and disease activity were similar in the MTX+PLA and MTX+ADA groups: age 54 vs 56 years; women 69% vs 63%; disease duration 83 vs 84 days; anti-CCP positive 70% vs 60%; IgM-RF positive 74% vs 70%; DAS28 (CRP) median 5.6 (range3.8-7.3) vs. 5.5 (3.8-7.8) respectively. The treatment had an excellent effect on inflammation but no effect on the dyslipidaemiae:

DAS28 Lipid levels mmol/L	Baseline Median (range)	Year 1 Median (range)	Year 2 Median (range)	Baseline % abnormal
DAS28(CRP)	5.6 (3.3-8.6)	2.0 (1.7-4.7)	2.0 (1.7-6.5)	–
Total s-cholesterol	4.8 (2.2-7.8)	5.1 (3.1-8.4)	5.1 (3.1-9.2)	50% >5.0
s-HDL	1.4 (0.7-2.7)	1.7 (0.8-3.6)	1.5 (0.7-2.8)	Male 53%>1.0 Female 84%>1.2
s-LDL	2.8 (0.8-6.1)	2.9 (0.9-6.1)	2.8 (0.9-5.9)	40%>3.0; 93%>1.8
S-VLDL	0.6 (0.1–1.7)	0.5 (0.2-1.6)	0.5 (0.2-1.7)
s-triglyceride	1.3 (0.3-3.8)	0.9 (0.4-3.5)	1.1 (0.4-3.8)	27%>1.7
s-Cholesterol / s-HDL	3.4 (1.7-9.8)	3.2 (1.3-7.2)	3.2 (1.8-7.3)	–

No effect of the efficient DMARD treatment strategy was observed after one or two years in any of the treatment arms regarding the levels of total s-cholesterol, s-HDL, s-LDL, s-VLDL or s-triglyceride (p-levels between 0.07-0.97). At baseline more than half of the 180 ERA patients had abnormal lipid concentrations compared to the reference levels.

Conclusion: In a Danish cohort of ERA patients (OPERA study) more than half of the patients had abnormal serum lipid concentrations at the time of diagnosis. Two years of effective synovitis suppression with MTX and glucocorticoid intraarticular and addition of ADA or PLA during the first year did not influence the dyslipidaemiae.

 

(1) Horslev-Petersen, K et al: Adalimumab Added to Methotrexate and Intra-Articular Glucocorticoid Increases Remission Rates At One Year In Early, DMARD-Naive Patients with Rheumatoid Arthritis-An Investigator-Initiated Randomized, Controlled, Double-Blinded Study. ARTHRITIS AND RHEUMATISM Vol 63 (10) Supplement: S147 Meeting Abstract 2011

---

« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/dyslipidaemia-in-early-rheumatoid-arthritis-patients-is-common-and-not-influenced-by-two-years-of-effective-dmard-therapy-the-opera-study/