Background/Purpose: Rheumatoid arthritis (RA) and dyslipidemia are associated with inflammation. Although the low-density lipoprotein cholesterol (LDL-C) is normal range, the high-density lipoprotein cholesterol (HDL-C) is reduced in RA patients. We aimed to investigate the influence of biological disease-modifying antirheumatic drugs (bDMARDs) on the LDL-C / HDL-C ratio in patients with RA.

Methods: Patients with RA treated with bDMARDs from 2008 to 2018 were studied based on the All Showa University of RA (ASHURA) database. The association between LDL-C and HDL-C level reduction and treatment was evaluated. Of 629 patients treated with the bDMARDs, 346 patients with available LDL-C and HDL-C levels medical records were included. The following background factors were investigated: age; sex; type of bDMARDs; dosage of methotrexate (MTX) and prednisolone (PSL); usage of conventional synthetic DMARDs, dyslipidemia drugs and nonsteroidal anti-inflammatory drugs; body mass index (BMI); smoking history; HbA1c; presence or absence of hypertension and dyslipidemia; and serum creatinine, C-reactive protein, and matrix metalloproteinase-3 levels. We also used the simplified disease activity index (SDAI) to evaluate RA disease activity. The primary endpoint was LDL-C and HDL-C levels before, and after 6 months and 1 year, which was determined using the repeated-measures analysis of variance (ANOVA).

Results: The LDL-C / HDL-C ratio were from 1.94 ± 0.76 to 1.88 ± 0.73 and 1.86 ± 0.74 before treatment and after 6 months and 1 year, respectively (p=0.328). Variation was within normal range (less than 2.0). The HDL-C levels increased from 61.8 ± 19.2 (mg/dL) to 64.8 ± 19.0 and 66.0 ± 19.2 before treatment and after 6 months and 1 year, respectively (p=0.013). Variation was within normal range (40-119). On the other hand, the LDL-C levels were not significant change from 110.2 ± 28.8 (mg/dL) to 112.3 ± 27.8 and 113.1 ± 28.1 before treatment and after 6 months and 1 year, respectively (p=0.372). Variation was within normal range (70-139).

Conclusion: Our study suggests that bDMARDs may affect increased HDL-C levels, not affect changes LDL-C levels and not affect LDL-C / HDL-C ratio in patients with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-biological-dmards-on-the-serum-low-density-lipoprotein-ldl-high-density-lipoprotein-hdl-cholesterol-ratio-in-patients-with-rheumatoid-arthritis/