Metabolic syndrome and its effect on the outcomes of rheumatoid arthritis in a multi-ethnic cohort in Singapore

• Published in: Clinical rheumatology Vol. 41; no. 3; pp. 649 - 660
• Main Authors: Hee, Jia Yi, Protani, Melinda M., Koh, Ee Tzun, Leong, Khai Pang
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2022; Springer Nature B.V
• Subjects: Adult; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - epidemiology; Cardiovascular disease; Cholesterol; Coronary artery disease; Cross-Sectional Studies; Demography; Ethnicity; Female; Heart diseases; Humans; Hypertriglyceridemia; Inflammation; Ischemia; Medicine; Medicine & Public Health; Metabolic syndrome; Metabolic Syndrome - complications; Metabolic Syndrome - epidemiology; Minority & ethnic groups; Original Article; Overexpression; Patients; Prevalence; Rheumatoid arthritis; Rheumatology; Risk Factors; Singapore - epidemiology; Stroke; Singapore; Multi-ethnic; Singapore; Disease outcomes; Metabolic syndrome; Rheumatoid arthritis
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-021-05945-8

Introduction Over-expression of common inflammatory mediators in the metabolic syndrome (MetS) and in rheumatoid arthritis (RA) may lead to mutually adverse outcomes. Aim We investigate the prevalence of MetS in a multi-ethnic population of RA patients and its effect on clinical and patient-reported outcomes. Method Six hundred sixty RA (561 women) patients from a public-sector specialist clinic in a hospital in Singapore were assessed for MetS according to the 2009 Joint Consensus (JC) and the 2004 National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) definitions. Univariable and multivariable regression modelling were used to investigate the associations between patients’ demographics with MetS and MetS with RA outcomes. Results The prevalence of MetS in our RA cohort was 49.4% and 44.9% according to the JC and NCEP ATP III definitions, respectively. The diagnosis of MetS was largely due to hypertriglyceridemia, hypertension, and obesity. MetS was associated with older age (OR 1.06 [95% CI 1.04–1.08]), Malay ethnicity (OR 1.78 [95% CI 1.02–3.09]), or Indian ethnicity (OR 3.07 [95% CI 1.68–5.59]). No significant associations between MetS and RA outcomes were observed. RA patients with MetS are more likely to suffer from stroke and ischemic heart disease. Conclusion The prevalence of MetS in RA patients in Singapore was almost double that in the general population. MetS does not adversely affect RA outcomes but raises the risks of stroke and heart disease. RA patients, especially those older and of Indian and Malay ethnicities, should be routinely screened for MetS. Any MetS-defining condition should be actively controlled. Key Points • Approximately half of the RA sample from the Singapore RA population can be diagnosed with MetS. • Older patients, and patients of Malay and Indian ethnicities have higher odds of MetS. • MetS does not adversely affect RA outcomes but raises the risks of stroke and heart disease.