Divsion of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea.
PLoS One. 2013 Jul 29;8(7):e68975. doi: 10.1371/journal.pone.0068975. Print 2013.
Dyslipidemia has been implicated in various musculoskeletal diseases, including rheumatoid arthritis (RA). Evidence is emerging that there might be a pathogenic interaction among inflammation, dyslipidemia, and adipokines. We prospectively investigated the association of cumulative lipid levels with radiographic progression of RA. RA patients (n=242) underwent plasma cholesterol assessment at four visits. Disease activity parameters and X-rays of the hands and feet were also serially monitored in these patients. The cumulative inflammatory burden and lipid levels were estimated by time-integrated values. Serum leptin and adiponectin concentrations were determined by ELISA. When patients were divided into three groups according to time-integrated lipid levels, as expected, patients with LDL cholesterol and/or triglyceride levels in the third tertile had persistently higher ESR and CRP levels. In parallel, a more rapid radiographic progression over two years was observed in patients with higher LDL cholesterol and/or triglyceride levels. In multivariate analysis, time-integrated LDL cholesterol was independently associated with radiographic progression. Particularly, the risk of radiographic progression was 5.6-fold in a subgroup with both LDL cholesterol and triglyceride levels in the third tertile. Moreover, LDL cholesterol synergistically increased the adjusted probability of radiographic progression in patients with high serum leptin levels but not in those without. These results demonstrate that LDL cholesterolemia is a novel serum marker that can be used to predict radiographic progression of RA, which seems to be related to circulatory leptin levels. We suggest that personalized and more aggressive anti-rheumatic therapy is required for dyslipidemic subgroups in RA patients.
脂代谢紊乱与多种肌肉骨骼疾病有关，包括类风湿关节炎（RA）。有证据表明，炎症、脂代谢紊乱和脂肪因子之间可能存在致病相互作用。我们前瞻性研究了累积血脂水平与 RA 放射学进展的相关性。242 例 RA 患者在 4 次就诊时进行了血浆胆固醇评估。这些患者还连续监测疾病活动参数和手部和足部 X 射线。通过时间积分值估计累积炎症负担和血脂水平。通过 ELISA 测定血清瘦素和脂联素浓度。当根据时间积分的血脂水平将患者分为三组时，正如预期的那样，LDL 胆固醇和/或三酰甘油水平处于第三三分位数的患者持续具有更高的 ESR 和 CRP 水平。同时，在两年内观察到更高 LDL 胆固醇和/或三酰甘油水平的患者出现更快的放射学进展。在多变量分析中，时间积分 LDL 胆固醇与放射学进展独立相关。特别是，在 LDL 胆固醇和三酰甘油水平均处于第三三分位数的亚组中，放射学进展的风险增加了 5.6 倍。此外，LDL 胆固醇与高血清瘦素水平的患者的放射学进展的调整后概率呈协同作用，但与无高血清瘦素水平的患者无协同作用。这些结果表明，LDL 胆固醇血症是一种新型血清标志物，可用于预测 RA 的放射学进展，这似乎与循环瘦素水平有关。我们建议，对于 RA 患者中的血脂异常亚组，需要进行个性化和更积极的抗风湿治疗。
