Atherogenic lipid profile is a feature characteristic of patients with early rheumatoid arthritis: effect of early treatment--a prospective, controlled study

Abstract

We investigated lipid profiles and lipoprotein modification after immuno-intervention in patients with early rheumatoid arthritis (ERA). Fifty-eight patients with ERA who met the American College of Rheumatology (ACR) criteria were included in the study. These patients had disease durations of less than one year and had not had prior treatment for it. Smokers or patients suffering from diabetes mellitus, hypothyroidism, liver or kidney disease, Cushing's syndrome, obesity, familiar dyslipidemia and those receiving medications affecting lipid metabolism were excluded from the study. Sixty-three healthy volunteers (controls) were also included. Patients were treated with methotrexate and prednisone. Lipid profiles, disease activity for the 28 joint indices score (DAS-28) as well as ACR 50% response criteria were determined for all patients. The mean DAS-28 at disease onset was 5.8 +/- 0.9. After a year of therapy, 53 (91.3%) patients achieved the ACR 20% response criteria, while 45 (77.6%) attained the ACR 50% criteria. In addition, a significant decrease in the DAS-28, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were observed. ERA patients exhibited higher serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides, whereas their serum high-density lipoprotein cholesterol (HDL-C) levels were significantly lower compared to controls. As a consequence, the atherogenic ratio of TC/HDL-C as well as that of LDL-C/HDL-C was significantly higher in ERA patients compared to controls. After treatment, a significant reduction of the atherogenic ratio of TC/HDL-C as well as that of LDL-C/HDL-C was observed, a phenomenon primarily due to the increase of serum HDL-C levels. These changes were inversely correlated with laboratory changes, especially CRP and ESR. In conclusion, ERA patients are characterized by an atherogenic lipid profile, which improves after therapy. Thus, early immuno-intervention to control disease activity may reduce the risk of the atherosclerotic process and cardiovascular events in ERA patients.

Figure 1

Correlation of total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) with C-reactive protein (CRP). Inverse correlation of CRP differences with (a) TC and (b) HDL-C differences (r = -0.54, p < 0.0001 and r = -0.59, p < 0.0001, respectively).

Figure 2

Correlation of total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) with erythrocyte sedimentation rate (ESR). Inverse correlation of ESR differences with (a) TC and (b) HDL-C differences (r = -0.28, p < 0.04 and r = -0.30, p < 0.03, respectively).

Figure 3

Cholesterol ester transfer protein (CETP) activity of controls and early rheumatoid arthritis patients before and after therapy. Data are expressed as means ± standard deviation. *p < 0.001 compared with controls; ^#p < 0.05 compared with pretreatment values.