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      Artrite reumatoide e síndrome metabólica Translated title: Rheumatoid arthritis and metabolic syndrome

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          Abstract

          Nos últimos 20 anos, tem sido demonstrado que a artrite reumatoide (AR) pode reduzir a expectativa de vida de 3 a 10 anos em comparação com a população em geral. Atualmente, a doença cardiovascular (DCV) é a principal causa de morte nos pacientes com AR, e a ocorrência de infarto agudo do miocárdio pode ser até quatro vezes maior nesses pacientes. A resposta inflamatória sistêmica de etiologia autoimune, somada à presença de síndrome metabólica (SM), torna duas vezes maior o risco de DCV fatal ou não fatal e da aterosclerose coronariana, independentemente da idade e sexo. A artrite reumatoide tem sido associada a aumento da prevalência de SM, mas o papel das diferentes características da doença, tais como a duração da doença, atividade e tratamento com glucocorticoides não estão bem definidos. O objetivo deste trabalho é revisar a prevalência de SM e os fatores implicados no desenvolvimento de aterosclerose nos pacientes com AR, avaliando os aspectos clínicos da AR e sua associação com o desenvolvimento de SM.

          Translated abstract

          In the past 20 years, the life expectancy of patients with rheumatoid arthritis (RA) has been shown to be reduced by three to ten years as compared to that of the general population. Currently, cardiovascular disease (CVD) is the major cause of death in patients with RA, and acute myocardial infarction can be up to four times more frequent in these patients. The autoimmune systemic inflammatory response, along with the presence of metabolic syndrome (MetS), doubles the risk for fatal or non-fatal CVD and coronary atherosclerosis, regardless of age and sex. Rheumatoid arthritis has been associated with increased prevalence of MetS, but its role in the different characteristics of the disease, such as disease duration, activity, and treatment with glucocorticoids, is not well defined. This study aimed at reviewing the prevalence of MetS and the factors implicated in the development of atherosclerosis in RA patients, assessing the clinical aspects of RA and its association with the development of MetS.

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          Most cited references46

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          Metabolic syndrome and 10-year cardiovascular disease risk in the Hoorn Study.

          Different definitions of the metabolic syndrome have been proposed. Their value in a clinical setting to assess cardiovascular disease (CVD) risk is still unclear. We compared the definitions proposed by the National Cholesterol Education Program Adult Treatment Panel III (NCEP), World Health Organization (WHO), European Group for the Study of Insulin Resistance (EGIR), and American College of Endocrinology (ACE) with respect to the prevalence of the metabolic syndrome and the association with 10-year risk of fatal and nonfatal CVD. The Hoorn Study is a population-based cohort study. The present study population comprised 615 men and 749 women aged 50 to 75 years and without diabetes or a history of CVD at baseline in 1989 to 1990. The prevalence of the metabolic syndrome at baseline ranged from 17% to 32%. The NCEP definition was associated with about a 2-fold increase in age-adjusted risk of fatal CVD in men and nonfatal CVD in women. For the WHO, EGIR, and ACE definitions, these hazard ratios were slightly lower. Risk increased with the number of risk factors. Elevated insulin levels were more prevalent in subjects with multiple risk factors, but metabolic syndrome definitions including elevated insulin level were not more strongly associated with risk. The metabolic syndrome, however defined, is associated with an approximate 2-fold increased risk of incident cardiovascular morbidity and mortality in a European population. In clinical practice, a more informative assessment can be obtained by taking into account the number of individual risk factors.
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            Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis.

            Patients with rheumatoid arthritis (RA) have accelerated atherosclerosis. The metabolic syndrome, a cluster of cardiovascular risk factors, identifies cardiovascular risk. We tested the hypotheses that patients with RA have a higher prevalence of the metabolic syndrome, particularly the WHO-defined syndrome that requires insulin resistance, and that this is associated with coronary atherosclerosis. The prevalence of the metabolic syndrome was determined using the modified WHO and NCEP III criteria in 154 patients with RA (88 with early RA and 66 with long-standing RA) and 85 control subjects. Coronary-artery atherosclerosis was detected by electron beam computed tomography. The WHO-defined metabolic syndrome was present in 42% of patients with long-standing RA, 31% with early RA and 11% of controls (P<0.001); the NCEP-defined metabolic syndrome was present in 42% of patients with long-standing RA, 30% with early RA and 22% of controls (P=0.03). Patients with the WHO-defined metabolic syndrome had an increased risk of having higher coronary-artery calcification scores, independent of age and sex (OR=2.02, 95% CI: 1.03-3.97, P=0.04). In conclusion, patients with RA have a higher prevalence of the metabolic syndrome than control subjects. Inflammation-associated metabolic syndrome is a mechanism that may contribute to increased coronary-artery atherosclerosis in RA.
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              Abdominal adiposity in rheumatoid arthritis: association with cardiometabolic risk factors and disease characteristics.

              Abdominal adiposity, especially visceral adiposity, is emerging as a recognized cardiometabolic risk factor. This study was undertaken to investigate how abdominal fat is distributed in rheumatoid arthritis (RA), and its RA-related determinants. Men and women with RA were compared with non-RA controls from the Multi-Ethnic Study of Atherosclerosis. Participants underwent anthropometric studies and quantification of visceral and subcutaneous fat areas (VFA and SFA) using abdominal computed tomography. A total of 131 RA patients were compared with 121 controls. Despite similar body mass index and waist circumference between the RA and control groups, the adjusted mean VFA was 45 cm2 higher (+51%) in male RA patients versus male controls (P = 0.005), but did not significantly differ by RA status in women. The adjusted mean SFA was 119 cm2 higher (+68%) in female RA patients versus female controls (P < 0.001), but did not significantly differ by RA status in men. Elevated VFA (≥75th percentile) was associated with a significantly higher adjusted probability of having an elevated fasting glucose level, hypertension, or meeting the composite definition of the metabolic syndrome in the RA group compared with controls. Within the RA group, rheumatoid factor seropositivity and higher cumulative prednisone exposure were significantly associated with a higher mean adjusted VFA. Higher C-reactive protein levels and lower Sharp/van der Heijde scores were significantly associated with both VFA and SFA. The distribution of abdominal fat differs significantly by RA status. Higher VFA in men with RA, and the more potent association of VFA with cardiometabolic risk factors in men and women with RA, may contribute to cardiovascular risk in RA populations.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbr
                Revista Brasileira de Reumatologia
                Rev. Bras. Reumatol.
                Sociedade Brasileira de Reumatologia (São Paulo, SP, Brazil )
                0482-5004
                1809-4570
                June 2011
                : 51
                : 3
                : 264-268
                Affiliations
                [05] orgnameHCPA orgdiv1Serviço de Reumatologia
                [01] orgnameHospital Universitário de Santa Maria
                [03] orgnameUFRGS orgdiv1Departamento de Medicina Interna
                [02] orgnameHospital de Clínicas de Porto Alegre
                [04] orgnameUFRGS orgdiv1Faculdade de Medicina orgdiv2Departamento de Medicina Interna
                Article
                S0482-50042011000300007
                10.1590/S0482-50042011000300007
                2464cc75-de5a-4ced-ae36-4db810a4fc01

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 15 February 2011
                : 04 February 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 5
                Product

                SciELO Brazil

                Categories
                Artigo de Revisão

                cardiovascular diseases,síndrome X metabólica,artrite reumatoide,doenças cardiovasculares,metabolic syndrome X,rheumatoid arthritis

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