Clinical study
Effects of antirheumatic therapy on serum lipid levels in patients with rheumatoid arthritis: a prospective study

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Abstract

Background

Patients with newly diagnosed rheumatoid arthritis have adverse serum lipid profiles. We sought to determine the effects of treating rheumatoid arthritis with antirheumatic drugs on these abnormal lipid levels.

Subjects and methods

We studied 42 patients with newly diagnosed rheumatoid arthritis who had not been treated with corticosteroids or disease-modifying antirheumatic drugs. We measured serum lipid profiles at baseline and 1 year later, and determined whether there were differences in the changes in lipid levels between patients who met the American College of Rheumatology criteria for a 20% improvement in rheumatoid arthritis and those who did not.

Results

Of the 42 patients, 27 (64%) met the criteria for a 20% improvement in rheumatoid arthritis during the 12-month study. In these patients, mean high-density lipoprotein (HDL) cholesterol levels increased by 21% (P <0.001), apolipoprotein A-I levels increased by 23% (P <0.001), and the ratio of low-density lipoprotein (LDL) cholesterol to HDL cholesterol level decreased by 13% (P = 0.10). There were significant between-group differences (responders–nonresponders) in the mean 12-month changes in HDL cholesterol levels (8.0 mg/dL; 95% confidence interval [CI]: 3 to 13 mg/dL; P = 0.002), apolipoprotein A-I levels (21 mg/dL; 95% CI: 8 to 33 mg/dL; P = 0.003), and the LDL cholesterol to HDL cholesterol ratio (–0.6; 95% CI: –0.1 to –1.0; P = 0.03), but not in LDL cholesterol, apolipoprotein B-100, or lipoprotein(a) levels.

Conclusion

Active rheumatoid arthritis is associated with an adverse lipid profile that improves substantially following effective treatment of rheumatoid arthritis. This improvement may reduce the risk of cardiovascular disease.

Section snippets

Study patients and design

Eligible patients were at least 18 years of age and had newly diagnosed rheumatoid arthritis that met the 1987 American Rheumatism Association criteria (14). We excluded patients if they had received corticosteroids or disease-modifying antirheumatic drugs before the study or if they had a clinical condition that affects lipid profiles, such as diabetes mellitus, dyslipidemia, hypothyroidism, nephrotic syndrome, alcoholism, chronic liver disease, Cushing syndrome, or obesity (body mass index

Results

Thirty-seven women and 5 men were enrolled, with a mean (± SD) age of 43 ± 12 years (range, 22 to 69 years) and a mean duration of rheumatoid arthritis of 27 ± 16 months. Twenty-seven patients (64%) were classified as responders (Table 1) according to the 20% improvement in rheumatoid arthritis activity criteria. Although all rheumatoid arthritis activity measures at baseline tended to be higher among responders, the only statistically significant difference was in C-reactive protein level (

Discussion

Our objective was to determine whether treating rheumatoid arthritis can reverse adverse lipid profiles in these patients. We followed patients with newly diagnosed rheumatoid arthritis who had not been treated with corticosteroids or disease-modifying antirheumatic drugs at baseline for 12 months. Patients received usual antirheumatic care; 64% of them achieved the American College of Rheumatology criteria for a 20% improvement by the end of the study. The improvement in several components of

Acknowledgements

The authors thank Drs. Fred Wolfe and John D. Seeger for their valuable review of the manuscript and Ms. Chan-Sook Shin for her research assistance.

References (36)

  • P.M. Ridker et al.

    C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women

    N Engl J Med

    (2000)
  • C.J. Packard et al.

    Lipoprotein-associated phospholipase A2 as an independent predictor of coronary heart disease. West of Scotland Coronary Prevention Study Group

    N Engl J Med

    (2000)
  • J. Danesh et al.

    Risk factors for coronary heart disease and acute-phase proteins. A population-based study

    Eur Heart J

    (1999)
  • A.E. Hak et al.

    Associations of C-reactive protein with measures of obesity, insulin resistance, and subclinical atherosclerosis in healthy, middle-aged women

    Arterioscler Thromb Vasc Biol

    (1999)
  • R.P. Tracy

    Inflammation markers and coronary heart disease

    Curr Opin Lipidol

    (1999)
  • D.P. Symmons et al.

    Long-term mortality outcome in patients with rheumatoid arthritisearly presenters continue to do well

    J Rheumatol

    (1998)
  • S. Wallberg-Jonsson et al.

    Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden

    J Rheumatol

    (1997)
  • O. Mutru et al.

    Ten year mortality and causes of death in patients with rheumatoid arthritis

    BMJ

    (1985)
  • Cited by (0)

    This study was supported by a research grant (1999) for research instructor at Yonsei University College of Medicine, Seoul, Korea.

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