Background/Purpose:   rheumatoid arthritis (RA) has been stablished as an independent risk factor for cardiovascular diseases. Metabolic syndrome (MS) may provide additional link between accelarated atherosclerosis and inflammation in RA. Objective: to estimate the prevalence of MS and modifiable and non-modifiable risk factors for cardiovascular disease among patients with RA, correlating them to disease activity markers.

Methods:  a cross-sectional study in patients with established RA (according to the ACR classification criteria) from three Brazilian university hospitals. Demographic and clinical data, and the presence of cardiovascular risk factors were collected. Blood pressure, weight, height and waist circumference were determined in the assessment visit and laboratory data were assessed from medical records. Disease activity was evaluated by the Disease Activity Score in 28 joints (DAS28), and patients were classified in remission <2.6; low disease activity (LDA) 2.6 to ≤3.2; moderate disease activity (MDA) >3.2 to ≤5.1; or high disease activity (HDA) >5.1. The diagnosis of MS was done according to the National Cholesterol Education Program (NCEP ATPIII 2005) and to the International Diabetes Foundation (IDF 2005). Remission was correlated to LDA, MDA and HDA in the analysis. Multiple logistic binary response analysis with Huber/White standard errors that accounted for clustering on hospitals was performed. Variables were sequentially deleted when not reaching significance equal to or less than 5%.

Results:  791 patients were included, 86.9% women, mean age 54.7 (±12) years, 59.9% Caucasian, mean disease duration of 12.8 (±8.9) years. Rheumatoid factor was positive in 75% of the patients, mean body mass index (BMI) was 27.1 (±4.9) kg/m²and mean waist circumference was 93.5 (±12.5) cm. Methotrexate were used by 67.7% and prednisone in 37.4% of the patients. Dyslipidemia, DM, HBP and family history of premature cardiovascular disease occurred in 34.3%, 15%, 49.2% and 16.5% of the patients, respectively. MS prevalence was 36.4% (NCEP) and 30.7% (IDF), with 91.5% of agreement. Age, dyslipidemia, HBP, DM and body mass index were associated with MS by NCEP and IDF definitions. MS (IDF) was associated to CRP levels (OR=1.30; p<0.001), to LDA (OR=1.62; p=0.001) and to MDA (OR=1.47; p<0.001). MS (IDF) and HAD association was fairly significant (OR=1.79; p=0.093). MS (NCEP) was associated to CRP levels (OR=1.32; p<0.001) and to HDA (OR=1.52; p=0.004). Dyslipidemia was positively correlated to LDA (OR=1.71; p=0.002), MDA (OR=1.51; p=0.001) and HDA (OR=1.77; p<0.001). HBP was positively correlated to LDA (OR=1.24; p<0.001). DM was positivily correlated to MDA (OR=1.83; p<0.001) and HDA (OR=3.18; p<0.001) and BMI was positivily correlated to MDA (OR=1.69; p= p<0.039) and HDA (OR=1.36; p=0.010).

Conclusion: our results depicted the association of MS to CRP levels and to DAS28, emphasizing the relevance of inflammation control in RA. Lipid, hypertension, diabetes and weight control are relevant metabolic aspect and should be valued and point to the more comprehensive medical approach. Disclosure of Interest:none declared

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/metabolic-syndrome-and-cardiovascular-risk-factors-in-brazilian-patients-with-established-rheumatoid-arthritis/