阿根廷类风湿关节炎患者代谢综合征的患病率及相关因素。

Prevalence and correlates of metabolic syndrome in patients with rheumatoid arthritis in Argentina.

机构信息

From the *Hospital Privado, †Instituto Reumatológico Strusberg, and ‡Instituto Modelo de Cardiología, Córdoba, Córdoba; §Hospital Italiano, Buenos Aires; ∥Hospital Provincial de Rosario, Santa Fé, ¶Hospital A. C. Padilla, Tucumán, #Centro de Rehabilitación II, Catamarca, **Centro Médico Privado de Reumatología, Tucumán, ††Organización Médica de Investigación, Buenos Aires, and ‡‡Hospital Cullen, Santa Fé, Argentina.

出版信息

J Clin Rheumatol. 2013 Dec;19(8):439-43. doi: 10.1097/RHU.0000000000000039.

DOI:10.1097/RHU.0000000000000039

PMID:24263146

Abstract

BACKGROUND

The increased mortality reported among patient with rheumatoid arthritis (RA) has been attributed to cardiovascular disease. Metabolic syndrome (MS) is a cluster of major risk factors for cardiovascular disease such as dyslipidemia, obesity, hypertension, and diabetes. There is a lack of reporting on the prevalence of MS in RA patients in Argentina.

OBJECTIVES

The objectives of this study were to determine and compare the frequency of MS in patients with RA and a control group and to assess the factors associated with MS.

METHODS

This is a cross-sectional study involving 1033 (409 RA and 624 age- and sex-matched control subjects) patients, followed up at 9 different rheumatology units in Argentina. Metabolic syndrome was defined according to the Adult Treatment Panel III (ATP III) and the International Diabetes Federation (IDF). The relationship between demographic variables, clinical data (disease duration, disease activity by Disease Activity Score of 28 joints, presence of rheumatoid factor [RF] and/or anti-cyclic citrullinated peptide antibody, presence of extra-articular manifestations), pharmacological treatment, and MS was examined by descriptive statistics. Variables with P ≤ 0.10 in these analyses were then examined by logistic regression.

RESULTS

The frequency of MS in RA patients and the control group was 30% versus 39% (P = 0.002) when defined as per the ATP III and 35% versus 40% (P = 0.10) as per the IDF. Variables independently associated with MS in RA patients were age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06 [P = 0.01] for the ATP III and OR, 1.03; 95% CI, 1.01-1.05 [P < 0.001] for the IDF), the presence of RF and/or anti-cyclic citrullinated peptide antibody (OR, 2.91; 95% CI, 1.11-7.61 [P = 0.02] for the ATP III and OR, 2.37; 95% CI, 1.09-5.16 [P = 0.02] for the IDF), and the use of hydroxychloroquine (OR, 0.48; 95% CI, 0.23-0.97 [P = 0.04] only for the IDF).

CONCLUSIONS

In this study, we were not able to demonstrate a higher frequency of MS in RA patients. However, older patients with positive RF or CCP have a higher risk of MS. A protective effect to develop MS was seen in the population treated with hydroxychloroquine.

摘要

背景

类风湿关节炎（RA）患者的死亡率增加归因于心血管疾病。代谢综合征（MS）是心血管疾病的主要危险因素群，如血脂异常、肥胖、高血压和糖尿病。在阿根廷，关于 RA 患者中 MS 的患病率缺乏报告。

目的

本研究的目的是确定和比较 RA 患者和对照组中 MS 的频率，并评估与 MS 相关的因素。

方法

这是一项横断面研究，涉及 1033 名（409 名 RA 和 624 名年龄和性别匹配的对照组）患者，在阿根廷的 9 个不同风湿病单位进行随访。代谢综合征根据成人治疗小组 III（ATP III）和国际糖尿病联合会（IDF）定义。通过描述性统计分析人口统计学变量、临床数据（疾病持续时间、28 个关节疾病活动评分、类风湿因子 [RF] 和/或抗环瓜氨酸肽抗体的存在、关节外表现的存在）、药物治疗与 MS 之间的关系。然后，通过逻辑回归分析这些分析中 P ≤ 0.10 的变量。

结果

RA 患者和对照组中 MS 的频率分别为 30%和 39%（P = 0.002），根据 ATP III 定义为 35%和 40%（P = 0.10），根据 IDF 定义。与 RA 患者 MS 独立相关的变量是年龄（优势比[OR]，1.03；95%置信区间[CI]，1.01-1.06 [P = 0.01]，ATP III 和 OR，1.03；95%CI，1.01-1.05 [P < 0.001]，IDF），RF 和/或抗环瓜氨酸肽抗体的存在（OR，2.91；95%CI，1.11-7.61 [P = 0.02]，ATP III 和 OR，2.37；95%CI，1.09-5.16 [P = 0.02]，IDF），以及羟氯喹的使用（OR，0.48；95%CI，0.23-0.97 [P = 0.04]，仅适用于 IDF）。