Metabolic Consequences of Rheumatoid Arthritis

Abstract

Patients with rheumatoid arthritis (RA) may have metabolic disruption, which can contribute to adverse long-term outcomes, for multiple reasons. Patients with RA appear to have a higher risk of sarcopenia, type 1 and type 2 diabetes mellitus, metabolic syndrome, and hypertension. Systemic inflammation in RA can cause a "lipid paradox," with reduced low-density lipoprotein being associated with higher rates of cardiovascular disease. In this review, we discuss changes to body composition, insulin resistance, lipids, and blood pressure that often occur in patients with RA. We examine the current understanding of the mechanisms underlying disruptions in metabolic pathways in RA, their clinical effects, and how treatment affects these changes.

Figure 1

Bidirectional relationship between obesity, inflammation, and metabolism, which collectively contribute to metabolic syndrome and CVD in RA. Listed in dark green are potentially beneficial interventions for each component. Long‐term adverse outcomes relevant to metabolic disruption are shown in the red box. CVD, cardiovascular disease; DMARD, disease‐modifying antirheumatic drug; RA, rheumatoid arthritis. Color figure can be viewed in the online issue, which is available at http://onlinelibrary.wiley.com/doi/10.1002/acr.25537/abstract.