Romatoid Artrit ve Ankilozan Spondilitli Hastalarda Metabolik Sendrom

Abstract

Amaç: Romatoid artrit (RA) ve ankilozan spondilitli (AS) hastalarda insülin direnci ve metabolik sendrom (MetS) prevalansını değerlendirmek ve karşılaştırmak, MetS’in hastalık aktivitesi ile ilişkisini ve MetS ile ilişkili faktörleri belirlemektir.

Materyal ve Metot: Kesitsel çalışma toplam 174 RA ve AS’li hasta içermektedir. MetS Uluslarası Diabet Federasyonu Kriterleri’ne (IDF) göre tanımlandı. İnsülin direnci Homeostas Model Assesment Index (HOMA) ile değerlendirildi. Hastalık aktivitesini ölçmek için 28 eklemi içeren hastalık aktivite skoru (DAS 28) ve Bath Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAI) kullanıldı. Fonksiyonel durumu Bath Ankilozan Spondilit Fonksiyonel İndeksi (BASFI) ve sağlık değerlendirme ölçeği (HAQ) kullanılarak değerlendirildi. MetS belirleyicilerini tanımlamak için çoklu regresyon analizi kullanıldı.

Bulgular: MetS prevalansı RA’lı hastalarda (%47) AS’li (%24,56) hastalardan daha yüksekti (p=0.005). İnsülin direnci prevalansı RA’lı hastalarda (%34,18) AS’li (%17,54) hastalardan daha yüksekti (p=0.031). MetS olan ve olmayan RA ve AS’li hastalar arasında hastalık aktivite skorları arasında anlamlı fark bulunmadı. (sırasıyla p=0,580 ve p=0,158). Yüksek BASDAI skorlarına sahip hasta sayısı MetS’li AS hastalarında daha yüksekti. Yaş ve vücut kitle indeksinin MetS için belirleyici olduğu saptandı (sırasıyla p=0,015 ve p<0,001).

Sonuç: AS’li hastalarla karşılaştırıldığında RA’lı hastalarda MetS ve insülin direnci yüksek oranda görüldü. MetS komponentlerinin ve hastalık aktivitesinin daha iyi kontrolü romatolojik hastalarda MetS prevalansının azalmasına yardımcı olabilir. 

Keywords

• Metabolik sendrom,romatoid artrit,ankilozan spondilit,hastalık

Metabolic Syndrome in Rheumatoid Arthritis and Ankylosing Spondylitis

Abstract

Objectives: To evaluate and compare the prevalence of insulin resistance and metabolic syndrome (MetS) in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and to determine the relationship of MetS with disease-activities and the factors associated with MetS.

Materials and Methods: The cross-sectional study included a total of 174 patients with RA and AS. MetS was defined according to the International Diabetes Federation (IDF) criteria. Insulin resistance was assessed with the Homeostasis Model Assessment (HOMA) Index. The Disease Activity Score including 28 joints (DAS28) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were used to measure disease activity. Functional status was evaluated using the Health Assessment Questionnaire (HAQ) and the Bath Ankylosing Spondylitis Functional Index (BASFI). Logistic regression analysis was applied to identify predictors of metabolic syndrome.

Results: The prevalence of MetS was significantly higher in patients with RA (47%) than in patients with AS (24.56%) (p=0.005). The prevalence of insulin resistance was significantly higher in patients with RA (34.18%) than in patients with AS (17.54%)(p=0.031). No significance difference was found in the disease activity score between RA and AS patients with metabolic syndrome and without metabolic syndrome (p=0.580 and p=0.158, respectively). The number of patients with a higher BASDAI score was greater in AS patients with MetS. Age and body mass index were determined to be predictors for MetS (p=0.015 and p<0.001, respectively).

Conclusion: Higher rates of MetS and insulin resistance were seen in RA patients compared to the patients with AS. Better control of the MetS components and disease activity may help to decrease the prevalence of MetS in rheumatic disease.

Keywords

• Metabolic syndrome,rheumatoid arthritis,ankylosing spondylitis,disease

References

1. 1. Sidiropoulos PI, Karvounaris SA, Boumpas DT. Metabolic syndrome in rheumatic diseases: epidemiology, pathophysiology, and clinical implications. Arthritis Res Ther 2008;10:207.
2. 2. Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg. Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation 2005;111:1448–54.
3. 3. Abella V, Scotece M, Conde J, et al. Adipokines, metabolic syndrome and rheumatic diseases. J Immunol Res 2014;2014:343746.
4. 4. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62:2569-81.
5. 5. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27:361-8.
6. 6. Kucukdeveci AA, Sahin H, Ataman S, Grif ths B, Tennant A. Issues in cross-cultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Rheum 2004;51:14-9.
7. 7. Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N. A Turkish version of the Bath Ankylosing Spondylitis Dis- ease Activity Index: reliability and validity. Rheumatol Int 2005;25:280-4. 8. Yanik B, Gursel YK, Kutlay S, Ay S, Elhan AH. Adaptation of the Bath Ankylosing Spondylitis Functional Index to the Turkish population, its reliability and va- lidity: functional assessment in AS. Clin Rheumatol 2005;24:41-7.
8. 9. Alberti KG, Zimmet P, Shaw J Metabolic syndrome: a new worldwide definition. A consensus statement from the International Diabetes Federation. Diabet Med 2006;23:469–80.

9. 10. Karvounaris SA, Sidiropoulos PI, Papadakis JA, et al Metabolic syndrome is common among middle-to-older aged Mediterranean patients with rheumatoid arthritis and correlates with disease activity: a retrospective, cross-sectional, controlled, study. Ann Rheum Dis 2007;66:28–33.
10. 11. Özmen M, Yersal Ö, Öztürk S, Soysal D, Köseeoğlu. Prevalence of the metabolic syndrome in rheumatoid arthritis 2014;1:1-4.
11. 12. Mok CC, Ko GT, Ho LY, Yu KL, Chan PT, To CH. Prevalence of atherosclerotic risk factors and the metabolic syndrome in patients with chronic inflammatory arthritis. Arthritis Care Res (Hoboken) 2011;63:195-202.
12. 13. Malesci D, Niglio A, Mennillo GA, Buono R, Valentini G, La Montagna G. High prevalence of metabolic syndrome in patients with ankylosing spondylitis. Clin Rheumatol 2007;26:710-4.
13. 14. Batmaz I, Karakoc M, Sariyildiz MA, et al. Metabolic Syndrome in Patients With Ankylosing Spondylitis J Endocrinol Metab 2011;1:215-9.
14. 15. Dąbrowski P, Majdan M. Insulin resistance and metabolic syndrome – a different image of disorders in rheumatoid arthritis and ankylosing spondylitis. Wiad Lek 2015;68:235-41.
15. 16. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C. American Heart Association; National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;27;109:433-8.
16. 17. Da Cunha VR, Brenol CV, Brenol JC, et al. Metabolic syndrome prevalence is increased in rheumatoid arthritis patients and is associated with disease activity. Scand J Rheumatol 2012;41:186–91.
17. 18. Papadakis JA, Sidiropoulos PI, Karvounaris SA, et al. High prevalence of metabolic syndrome and cardiovascular risk factors in men with ankylosing spondylitis on anti-TNFalpha treatment: correlation with disease activity. Clin Exp Rheumatol 2009;27:292-8.
18. 19. Salinas MJ, Bertoli AM, Lema L, et al Prevalence and correlates of metabolic syndrome in patients with rheumatoid arthritis in Argentina. J Clin Rheumatol 2013;19:439–43.
19. 20. de Oliveira BM, Medeiros MM, de Cerqueira JV, de Souza Quixadá RT, de Oliveira ÍM. Metabolic syndrome in patients with rheumatoid arthritis followed at a University Hospital in Northeastern Brazil. Rev Bras Reumatol Engl 2016;56:117-25.
20. 21. Yanovski SZ, Yanovski JA . Obesity. N Engl J Med 2002; 346:591–602.
21. 22. Festa A, D’Agostino R Jr, Howard G et al. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000;102:42–7.