The relationship between weight status and metabolic syndrome in patients with rheumatoid arthritis and spondyloarthritis - 04/09/20

Doi : 10.1016/j.jbspin.2020.07.008

Charlotte Giraud ^a,^b, Céline Lambert ^c, Frédéric Dutheil ^d, Bruno Pereira ^c, Martin Soubrier ^a,^b, Anne Tournadre ^a,^b,^⁎
^a Rheumatology department, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
^b UNH-UMR 1019, INRAe and University of Clermont-Auvergne, 63003 Clermont-Ferrand, France
^c Biostatistics unit (DRCI), CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
^d Preventive and Occupational Medicine, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France

^⁎Corresponding author at: Rheumatology Department, Hôpital G. Montpied, 58, rue Montalembert, BP69, 63003 Clermont-Ferrand Cedex 1, France.Rheumatology Department, Hôpital G. Montpied58, rue Montalembert, BP69Clermont-Ferrand Cedex 163003France

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Highlights

•	Metabolic health is not uniform among RA and SpA patients with similar BMI.
•	In RA, metabolic syndrome did not increase with bodyweight and was not associated with fat.
•	Conversely, in SpA metabolic syndrome was associated with body fat and cardiovascular risk.

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Abstract

Objectives

To compare the prevalence and correlates of metabolic syndrome (MetS) stratified by body mass index (BMI) categories in rheumatoid arthritis (RA) and spondyloarthritis (SpA).

Methods

The age- and sex-standardized prevalence of MetS was calculated by BMI categories and compared between RA and SpA patients before starting first biologic, and controls. The determinants of metabolic syndrome in patients without obesity were investigated.

Results

MetS was observed in 28% of RA (21/75), 22.5% of SpA (18/80), 19% of controls (187/998). The age- and sex-standardized prevalence of MetS was not significantly different between RA 19% (95% CI: 11–27%), SpA 26% (95% CI: 16–36%) and controls 16% (95% CI: 14–18%). When stratified by BMI, the standardized prevalence of MetS was less frequent in obese RA patients (15%, 95% CI: 4–27%) compared to obese controls (48%, 95% CI: 40–55%) or to obese SpA (36%, 95% CI: 26–45%). In normal-weight RA patients, MetS standardized prevalence was 16% (95% CI: 7–25%) compared to 5% (95% CI: 0–11%) in SpA, and 6% (95% CI: 4–8%) in controls. In non-obese SpA, MetS was associated with abdominal obesity, visceral fat mass and cardiovascular risk. In non-obese RA patients with metabolic syndrome, body composition did not differ from metabolically healthy RA patients.

Conclusions

MetS is not uniform among patients with similar BMI. In RA, MetS was less frequent in obese patients, and unlike SpA, was not associated with body fat composition in non-obese patients. Differences between RA and SpA for metabolic health suggest various pathophysiological mechanisms.

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Keywords : Metabolic syndrome, Obesity, Rheumatoid arthritis, Spondyloarthritis