Background/Purpose: Systemic sclerosis (SSc) is a multisystem autoimmune disease characterized by initial vascular injuries and resulted fibrosis of skin and internal organs. Vascular impairment in SSc involves both micro and macrovascular circulation and maybe a sign of endothelial dysfunction. Metabolic syndrome (MetS) is defined as a set of metabolic abnormalities which commonly manifests together and are considered to be cardiovascular risk factors. Each component by itself increases the risk for cardiovascular disease (CVD), however, when combined, a 1.5 – 2.5 increase in CVD mortality is observed. Objective:To determine the prevalence and features of metabolic syndrome (MetS) in SSc.

Methods: We screened consecutive SSc patients followed in a longitudinal cohort from 2011 to 2013 and age and sex matched controls. We excluded patients with overlapping rheumatic diseases. Predefined outcome measures were collected. This included demographics (age, gender, disease duration), physical examination [skin score, joint count, blood pressure, height, weight, waist circumference (WC) and hip circunference (HC)], disease activity (Valentini Disease Activity Index) and severity (Medsger Disease Severity Scale) scores and laboratory data (total and fractions of cholesterol, fasting glucose levels, basal insulin, C3, C4, erythrocyte sedimentation rate and hemoglobin/hematocrit levels). MetS was assessed using the definition recommended by the 2009 Joint Interim Statement (JIS). Nonparametric tests and correlation were used for statistical analysis. 

Results: A total of 131 SSc (121 female; mean age = 51.70; SD=13.12) and 79 health subjects (69 female; mean age=40.66; SD=13.38) (p=0.41) were included in the study. Seventy-eight (59.54%) patients had limited SSc (lSSc); 42(32.06%) had diffuse SSc (dSSc) and 11(8.4%) SSc sine scleroderma disease (ssSSc). Active disease was observed in 18(13.74%) SSc (10 lSSc and 8 dSSc) patients. Hypertension was identified in 35 (26.72%)SSc and in 3 (3.8%) controls (p<0.001), diabetes mellitus in 16 (12.21%) SSc patients and in 3 (3.8%) controls (p=0.04) and lipid profile abnormalities in 83 (63.36%) SSc patients and in 10 (12.6%) controls (p<0.001). Increased LDL [94 (71.76%) ], increased triglycerides [49 (37.40%)] and reduced HDL [75 (57.25%)] were the lipid abnormalities more often observed in SSC when compared to controls (p<0.01). Abnormal abdominal circumference was observed in 105 (80.15%) SSc patients and in 54 (68.35%) controls (p=0.05). MetS was identified in 52 (39.69%) SSc patients and 7 (8.86%) controls (p<0.001). We did not observe an association between MetS and SSc subtype (p=0.76), disease activity (p=0.66), prednisone use (p=0.093) and severity index (p=0.1). 

Conclusion: This is the first study to determine the prevalence and features of MetS in SSC. MetS is frequently observed in SSc and not associated with disease related features in this cohort. However MetS should be routinely screened since it can influence atherosclerosis and cardiovascular mortality in SSc.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-and-features-of-metabolic-syndrome-in-systemic-sclerosis/