Boers M, Nurmohamed M T, Doelman C J A, Lard L R, Verhoeven A C, Voskuyl A E, Huizinga T W J, van de Stadt R J, Dijkmans B A C, van der Linden Sj
Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
Ann Rheum Dis. 2003 Sep;62(9):842-5. doi: 10.1136/ard.62.9.842.
Glucocorticoids induce hypercholesterolaemia, a cardiovascular risk factor, in patients with diseases other than rheumatoid arthritis (RA), but the data in RA are contradictory.
To determine the effects of antirheumatic treatment, including prednisolone (combination) therapy on total and high density lipoprotein (HDL) cholesterol levels in RA, taking disease activity into account.
HDL cholesterol and total cholesterol levels were determined in:(a) established RA (b) two cohorts with early active RA, (c) a previously conducted 56 week trial among patients with early RA comparing the value of intensive combination therapy (that included glucocorticoids) with sulfasalazine alone (COBRA trial).
In established RA total cholesterol levels were only slightly raised, irrespective of disease activity. However, HDL cholesterol was significantly higher in patients in remission than in patients with active disease. In contrast, in active early RA at baseline total cholesterol was low normal: between 4.6 and 5.1 mmol/l in the different populations. The level of HDL cholesterol was highly dependent on the duration of storage. In both COBRA groups total cholesterol increased by a mean of 0.6 mmol/l. HDL cholesterol increased by more than 50% after treatment, leading to an improvement of the total cholesterol/HDL ratio (atherogenic index). This increase (and index improvement) was much more rapid in the group receiving combination treatment. A similar pattern was seen in the 2001 cohort with early RA. In all the groups with active disease HDL and total cholesterol levels correlated inversely with disease activity.
In established, but especially in early RA, disease activity is accompanied by atherogenic lipid levels. This dyslipidaemia can be rapidly reversed by aggressive antirheumatic treatment including glucocorticoids.
糖皮质激素可在类风湿关节炎（RA）以外的疾病患者中诱发高胆固醇血症，这是一种心血管危险因素，但RA患者中的相关数据存在矛盾。
考虑疾病活动度，确定抗风湿治疗（包括泼尼松龙联合治疗）对RA患者总胆固醇和高密度脂蛋白（HDL）胆固醇水平的影响。
在以下人群中测定HDL胆固醇和总胆固醇水平：（a）确诊的RA患者；（b）两个早期活动性RA队列；（c）先前在早期RA患者中进行的一项为期56周的试验，比较强化联合治疗（包括糖皮质激素）与单用柳氮磺胺吡啶的疗效（COBRA试验）。
在确诊的RA患者中，无论疾病活动度如何，总胆固醇水平仅略有升高。然而，缓解期患者的HDL胆固醇显著高于活动期患者。相比之下，在基线时处于活动期的早期RA患者中，总胆固醇处于正常低水平：不同人群中为4.6至5.1 mmol/l。HDL胆固醇水平高度依赖于储存时间。在COBRA试验的两个组中，总胆固醇平均升高0.6 mmol/l。治疗后HDL胆固醇升高超过50%，导致总胆固醇/HDL比值（致动脉粥样硬化指数）改善。接受联合治疗的组中这种升高（以及指数改善）更为迅速。在2001年的早期RA队列中也观察到类似模式。在所有活动期疾病组中，HDL和总胆固醇水平与疾病活动度呈负相关。
在确诊的RA患者中，尤其是早期RA患者，疾病活动伴有致动脉粥样硬化的血脂水平。包括糖皮质激素在内的积极抗风湿治疗可迅速逆转这种血脂异常。
