Frequency of Metabolic Syndrome in Individuals Diagnosed with Rheumatoid Arthritis and Its Relationship with Inflammatory Parameters

Abstract

OBJECTIVE: The aim of this study is to investigate the relationship between rheumatoid arthritis (RA) and metabolic syndrome (MetS), to evaluate the prevalence of MetS in patients with RA and its association with biomarkers [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lipid profile, vitamin D], and to explore the effects of antirheumatic therapies on metabolic parameters. It is known that MetS increases cardiovascular risk in RA patients; thus, clarifying this relationship is critically important for patient management. MATERIALS AND METHODS: This study was designed as a cross-sectional cohort analysis, including 270 RA patients followed in a single center. Demographic, clinical, and laboratory data of patients were collected retrospectively. MetS diagnosis was established according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Disease activity markers for RA (CRP, ESR), lipid profiles, vitamin D levels, and treatment details were recorded. Student’s t-test, Mann-Whitney U test, and chi-square test were used for statistical comparisons between groups. RESULTS: The prevalence of MetS among RA patients was found to be 31.7%. Patients with MetS had significantly higher metabolic risk factors, such as body mass index (32.7 kg/m²), hypertension (95%), and hypertriglyceridemia (86%). No significant differences were observed in CRP and ESR levels between patients with and without MetS. Although vitamin D deficiency was common, it was not significantly associated with MetS. Furthermore, no significant relationship was identified between RA treatments (methotrexate, biological agents) and MetS. CONCLUSION: The prevalence of MetS in patients with RA is higher compared to the general population, leading to increased cardiovascular risk. In RA patients whose disease activity is well-controlled, the inflammation-metabolic risk relationship may diminish. A “treat-to-target” approach in RA management should encompass both joint-related and cardiometabolic outcomes. Early diagnosis and management of MetS can improve quality of life and prognosis in RA patients.

Keywords

• Rheumatoid arthritis
• metabolic syndrome
• cardiovascular risk
• inflammation
• antirheumatic therapy
• vitamin D

Romatoid Artrit Tanılı Bireylerde Metabolik Sendrom Sıklığı ve İnflamatuvar Parametrelerle İlişkisi

Abstract

AMAÇ: Bu çalışmanın amacı, romatoid artrit (RA) ve metabolik sendrom (MetS) arasındaki ilişkiyi incelemek, RA hastalarında MetS prevalansını ve biyobelirteçlerle [C-reaktif protein (CRP, eritrosit sedimantasyon hızı (ESH), lipid profili, D vitamini] ilişkisini değerlendirmek, ayrıca anti-romatizmal tedavilerin metabolik parametreler üzerindeki etkilerini araştırmaktır. RA’lı hastalarda MetS’nin kardiyovasküler riski artırdığı bilinmekte olup, bu ilişkinin aydınlatılması hasta yönetimi açısından kritik öneme sahiptir. GEREÇ ve YÖNTEM: Kesitsel bir kohort analizi olarak tasarlanan bu çalışmada, tek merkezde takipli 270 RA hastası incelendi. Hastaların demografik, klinik ve laboratuvar verileri retrospektif olarak toplandı. MetS tanısı Ulusal Kolesterol Eğitim Programı (NCEP ATP III) kriterlerine göre konuldu. RA hastalık aktivitesi (CRP, ESH), lipid profili, D vitamini düzeyleri ve tedavi detayları kaydedildi. İstatistiksel analizlerde gruplar arası karşılaştırmalar için Student t-testi, Mann-Whitney U testi ve ki-kare testi kullanıldı. BULGULAR: RA hastalarında MetS prevalansı %31,7 olarak bulundu. MetS’li hastalarda vücut kitle indeksi (32,7 kg/m²) ve hipertansiyon (%95), hipertrigliseridemi (%86) gibi metabolik risk faktörleri belirgin şekilde daha yüksekti. CRP ve ESH düzeyleri MetS’li ve MetS’siz gruplar arasında farklılık göstermedi. D vitamini eksikliği yaygın olmakla birlikte, MetS ile anlamlı bir ilişki saptanmadı. RA tedavileri (metotreksat, biyolojik ajanlar) ile MetS arasında belirgin bir ilişki gözlenmedi. SONUÇ: RA hastalarında MetS prevalansı genel popülasyona göre daha yüksektir ve kardiyovasküler riski artırmaktadır. İyi kontrol altındaki RA hastalarında enflamasyon-metabolik risk ilişkisi hafifleyebilir. RA tedavisinde “tüm hedefler için tedavi” yaklaşımı hem eklem hem de kardiyometabolik sonuçlar için benimsenmelidir. MetS’nin erken tanı ve yönetimi, RA hastalarının yaşam kalitesini ve prognozunu iyileştirebilir.

Keywords

• Romatoid artrit
• metabolik sendrom
• kardiyovasküler risk
• enflamasyon
• antiromatizmal tedavi
• D vitamini

References

1. 1. Cai W, Tang X, Pang M. Prevalence of Metabolic Syndrome in Patients With Rheumatoid Arthritis: An Updated Systematic Review and Meta-Analysis. Front Med (Lausanne). 2022; 9: 855141.
2. 2. Chiu YM, Lu YP, Lan JL, Chen DY, Wang JD. Lifetime Risks, Life Expectancy, and Health Care Expenditures for Rheumatoid Arthritis: A Nationwide Cohort Followed Up From 2003 to 2016. Arthritis Rheumatol. 2021; 73: 750-758.
3. 3. Hallajzadeh J, Safiri S, Mansournia MA, Khoramdad M, Izadi N, Almasi-Hashiani A, et al. Metabolic syndrome and its components among rheumatoid arthritis patients: A comprehensive updated systematic review and meta-analysis. PLoS One. 2017; 12: e0170361.
4. 4. Luo P, Xu W, Ye D, Chen W, Ying J, Liu B, et al. Metabolic Syndrome Is Associated With an Increased Risk of Rheumatoid Arthritis: A Prospective Cohort Study Including 369,065 Participants. J Rheumatol. 2024; 51: 360-367.
5. 5. Maruotti N, d'Onofrio F, Cantatore FP. Metabolic syndrome and chronic arthritis: effects of anti-TNF-alpha therapy. Clin Exp Med. 2015; 15: 433-438.
6. 6. Grzechnik K, Targonska-Stepniak B. Metabolic Syndrome and Rheumatoid Arthritis Activity: An Analysis of Clinical, Laboratory, and Ultrasound Parameters. Nutrients. 2023; 15: 4756.
7. 7. Baker JF, Reed G, Mikuls TR, Thiele GM, Pappas DA, Charles-Schoeman C, et al. Metabolic Syndrome, Adipokines, and Response to Advanced Therapies in Rheumatoid Arthritis. Arthritis Rheumatol. 2025; 77: 263-271.
8. 8. Ferraz-Amaro I, Gonzalez-Juanatey C, Lopez-Mejias R, Riancho-Zarrabeitia L, Gonzalez-Gay MA. Metabolic syndrome in rheumatoid arthritis. Mediators Inflamm. 2013; 2013: 710928.

9. 9. Burli AP, Dave M. Clinical & Demographic Profile and Prevalence of Metabolic Syndrome Among Patients with Rheumatoid Arthritis and its Correlation with Disease Activity. J Assoc Physicians India. 2022; 70: 11-12.
10. 10. Macakova K, Tekelova M, Mlynarikova V, Sebekova K, Vlkova B, Celec P, et al. Metabolic Effects of Anti-TNF-alpha Treatment in Rheumatoid Arthritis. Diseases. 2023; 11: 164.
11. 11. Baker JF, Mehta NN, Baker DG, Toedter G, Shults J, Von Feldt JM, et al. Vitamin D, metabolic dyslipidemia, and metabolic syndrome in rheumatoid arthritis. Am J Med. 2012; 125: 1036.e9-1036.e15.
12. 12. Haque UJ, Bathon JM, Giles JT. Association of vitamin D with cardiometabolic risk factors in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012; 64: 1497-1504.
13. 13. Cai W, Tang X, Pang M. Prevalence of Metabolic Syndrome in Patients With Rheumatoid Arthritis: An Updated Systematic Review and Meta-Analysis. Front Med (Lausanne). 2022; 9: 855141.
14. 14. Karahan AY, Bağçacı S, Salbaş E, Erol K, Karpuz S, Küçük A. The assessment of knowledge level about their disease in patients with rheumatoid arthritis. Journal of Clinical and Experimental Investigations. 2014; 5: 429-434.
15. 15. Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017; 76: 17-28.