Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort

Ben Parker¹, Murray B Urowitz², Dafna D Gladman², Mark Lunt¹, Rachelle Donn³, Sang-Cheol Bae⁴, Jorge Sanchez-Guerrero⁵, Juanita Romero-Diaz⁵, Caroline Gordon⁶, Daniel J Wallace⁷, Ann E Clarke⁸, Sasha Bernatsky⁸, Ellen M Ginzler⁹, David A Isenberg¹⁰, Anisur Rahman¹⁰, Joan T Merrill¹¹, Graciela S Alarcón¹², Barri J Fessler¹², Paul R Fortin¹³, John G Hanly¹⁴, Michelle Petri¹⁵, Kristjan Steinsson¹⁶, Mary Anne Dooley¹⁷, Susan Manzi¹⁸, Munther A Khamashta¹⁹, Rosalind Ramsey-Goldman²⁰, Asad A Zoma²¹, Gunnar K Sturfelt²², Ola Nived²², Cynthia Aranow²³, Meggan Mackay²³, Manuel Ramos-Casals²⁴, Ronald F van Vollenhoven²⁵, Kenneth C Kalunian²⁶, Guillermo Ruiz-Irastorza²⁷, S Sam Lim²⁸, Diane L Kamen²⁹, Christine A Peschken³⁰, Murat Inanc³¹, Ian N Bruce¹

Affiliations

¹ Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Toronto, Ontario, Canada.
² Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.
³ Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
⁴ Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
⁵ Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
⁶ Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
⁷ Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
⁸ Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
⁹ Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA.
¹⁰ Centre for Rheumatology Research, University College, London, UK.
¹¹ Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.
¹² Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹³ Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada.
¹⁴ Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁵ Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹⁶ Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland.
¹⁷ Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
¹⁸ Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
¹⁹ Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK.
²⁰ Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA.
²¹ Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK.
²² Department of Rheumatology, University Hospital Lund, Lund, Sweden.
²³ Feinstein Institute for Medical Research, Manhasset, New York, USA.
²⁴ Department of Autoimmune Diseases, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Hospital Clínic, Barcelona, Spain.
²⁵ Unit for Clinical Therapy Research (ClinTRID), The Karolinska Institute, Stockholm, Sweden.
²⁶ UCSD School of Medicine, La Jolla, California, USA.
²⁷ Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
²⁸ Emory University, Atlanta, Georgia, USA.
²⁹ Medical University of South Carolina, Charleston, South Carolina, USA.
³⁰ University of Manitoba, Winnipeg, Manitoba, Canada.
³¹ Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

PMID: 24692585
PMCID: PMC4515988
DOI: 10.1136/annrheumdis-2013-203933

Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort

Ben Parker et al. Ann Rheum Dis. 2015 Aug.

. 2015 Aug;74(8):1530-6.

doi: 10.1136/annrheumdis-2013-203933. Epub 2014 Apr 1.

Authors

Affiliations

¹ Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Toronto, Ontario, Canada.
² Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.
³ Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
⁴ Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
⁵ Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
⁶ Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
⁷ Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
⁸ Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
⁹ Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA.
¹⁰ Centre for Rheumatology Research, University College, London, UK.
¹¹ Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.
¹² Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹³ Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada.
¹⁴ Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁵ Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹⁶ Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland.
¹⁷ Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
¹⁸ Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
¹⁹ Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK.
²⁰ Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA.
²¹ Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK.
²² Department of Rheumatology, University Hospital Lund, Lund, Sweden.
²³ Feinstein Institute for Medical Research, Manhasset, New York, USA.
²⁴ Department of Autoimmune Diseases, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Hospital Clínic, Barcelona, Spain.
²⁵ Unit for Clinical Therapy Research (ClinTRID), The Karolinska Institute, Stockholm, Sweden.
²⁶ UCSD School of Medicine, La Jolla, California, USA.
²⁷ Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
²⁸ Emory University, Atlanta, Georgia, USA.
²⁹ Medical University of South Carolina, Charleston, South Carolina, USA.
³⁰ University of Manitoba, Winnipeg, Manitoba, Canada.
³¹ Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

PMID: 24692585
PMCID: PMC4515988
DOI: 10.1136/annrheumdis-2013-203933

Abstract

Background: The metabolic syndrome (MetS) may contribute to the increased cardiovascular risk in systemic lupus erythematosus (SLE). We examined the association between MetS and disease activity, disease phenotype and corticosteroid exposure over time in patients with SLE.

Methods: Recently diagnosed (<15 months) patients with SLE from 30 centres across 11 countries were enrolled into the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort from 2000 onwards. Baseline and annual assessments recorded clinical, laboratory and therapeutic data. A longitudinal analysis of factors associated with MetS in the first 2 years of follow-up was performed using random effects logistic regression.

Results: We studied 1150 patients with a mean (SD) age of 34.9 (13.6) years and disease duration at enrolment of 24.2 (18.0) weeks. In those with complete data, MetS prevalence was 38.2% at enrolment, 34.8% at year 1 and 35.4% at year 2. In a multivariable random effects model that included data from all visits, prior MetS status, baseline renal disease, SLICC Damage Index >1, higher disease activity, increasing age and Hispanic or Black African race/ethnicity were independently associated with MetS over the first 2 years of follow-up in the cohort.

Conclusions: MetS is a persistent phenotype in a significant proportion of patients with SLE. Renal lupus, active inflammatory disease and damage are SLE-related factors that drive MetS development while antimalarial agents appear to be protective from early in the disease course.

Keywords: Cardiovascular Disease; Inflammation; Systemic Lupus Erythematosus.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Figures

**Figure 1**
Prevalence of metabolic syndrome over time by race/ethnicity. FU, follow-up.

**Figure 2**
Persistence and variability of metabolic syndrome (MetS) over time in a complete case analysis (n=399). FU, follow-up

**Figure 3**
Metabolic syndrome (MetS) characteristics by race/ethnicity. BP, blood pressure; FU, follow-up, HDL, high-density lipoprotein; TG, triglyceride; WC, waist circumference.

See this image and copyright information in PMC

References

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Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort

Affiliations

Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical