Objective We compared the prevalence and the clustering of the Metabolic Syndrome (MetS) components: obese body mass index (BMI ≥ 30 kg/m2), hypertriglyceridemia, low high-density lipids, hypertension and diabetes, in patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA) in the Consortium of Rheumatology Researchers of North America (CORRONA) registry. Methods We included CORRONA participants with the rheumatologist-confirmed clinical diagnoses of PsA and RA with complete data. We used a modified definition of MetS that did not include insulin resistance, waist circumference or blood pressure measurements. Logistic regression models were adjusted for age, sex and race. Results In the overall CORRONA population, the rates of diabetes and obesity were significantly higher in PsA compared with RA. In 294 PsA and 1162 RA participants who had lipids measured, the overall prevalence of MetS in PsA vs. RA was 27% vs. 19%. The odds ratio (OR) of MetS in PsA vs. RA was 1.44 (95% confidence interval (CI) 1.05 to 1.96), p=0.02. The prevalence of hypertriglyceridemia was higher in PsA compared with RA, 38% vs. 28%, OR 1.51 (95% CI 1.15 to 1.98), p=0.003. The prevalence of type II diabetes was also higher in PsA compared with RA (15% vs. 11%), OR 1.56 (95% CI 1.07 to 2.28), p=0.02, in the adjusted model. Similarly, higher rates of hypertriglyceridemia and diabetes were observed in the subgroup of PsA and RA patients with obese BMI. Conclusion PsA is associated with the higher rates of obesity, diabetes, and hypertriglyceridemia, compared with RA.

ObjectivesThe new 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for rheumatoid arthritis (RA) have been designed to classify early onset RA, but has not been studied to identify RA in patients with arthritis seen in routine clinical care where correct ‘classification’ of patients, when they are not selected for having RA would be important.DesignProspective, consecutive patients cohort.SettingOutpatient clinic of a university rheumatology centre.ParticipantsA total of 126 patients with joint symptoms were consecutively recruited.InterventionsThe ACR/EULAR RA criteria were applied, with questions followed by a targeted musculoskeletal exam. The gold standard for the diagnosis of RA was the primary rheumatologist's diagnosis.Primary outcome measureNumber of patients with non-RA diagnosis who were classified as having RA by the new classification criteria.ResultsThe sensitivity and specificity of the 2010 criteria in classifying RA were 97% and 55%, respectively, compared with the 1987 RA criteria which were 93% and 76%, respectively. The 2010 criteria as applied to this group of patients had a poorer positive predictive (44% vs 61%) and a similar negative predictive value (98% vs 97%) compared with the 1987 criteria. More specifically, 66.7% of systemic lupus erythematosus patients, 50% of osteoarthritis, 37.5% of psoriatic arthritis and 27.2% of others fulfilled the new criteria and could have been classified as RA.ConclusionsIn this, we believe, the first study to examine the new 2010 ACR/EULAR RA criteria among consecutive patients seen in routine care, we found the criteria to have low specificity, and therefore incorrectly label those as having RA when, in fact, they may have a different type of inflammatory arthritis. Physicians need to be aware of this when applying the new criteria for classifying their patients for any purpose.

Background: Obesity and abdominal adiposity have been associated with inflammation as have the presence of anti-nuclear antibodies (ANAs). It was recently reported that there is a decreased likelihood of ANAs in the obese general population. To examine this relationship we used data from adult participants in the National Health and Nutrition and Examination Survey 1999Survey -2004

Background Psoriatic arthritis (PsA) is associated with a higher frequency of abnormal lipids and obesity compared with healthy controls and rheumatoid arthritis. There is also an increased risk of developing PsA in obese individuals, perhaps related to the inflammatory milieu provided by excess adiposity. It is also known that inflammatory cytokines contribute to derangements in lipid metabolism. However, the relationship between disease activity and lipid profiles in PsA is not well studied. Objectives To assess the cross-sectional relationship between PsA disease activity and lipid profiles in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. Methods We analyzed PsA patients followed in CORRONA between 6/2008 and 10/2012 with complete data for lipids and disease activity. Moderate to high disease activity was defined as CDAI>10 and/or presence of enthesitis/dactylitis. Abnormal lipids were defined as: total cholesterol (TC)>200 mg/dl (5.17 mmol/L), High Density Lipoprotein (HDL)<40 mg/dl (1.0 mmol/L, men), HDL<50 mg/dl (1.3 mmol/L, women), Low Density Lipoprotein (LDL)>100 mg/dl (2.59 mmol/L), Triglycerides (TG)>150 mg/dl (1.7 mmol/L), and atherogenic ratio (TC/HDL) >5. Models were adjusted for gender, duration of PsA, mHAQ, disease-related medication use, smoking, body mass index (BMI), diabetes (DM), use of cholesterol medications and fish oil. Results Of the 725 PsA patients included in this study, 284 (39%) had moderate to high disease activity. Compared to the low disease activity group, the moderate to high disease activity group had a higher proportion of women (57% vs 46%, p=0.006) and smokers (12.7% vs 7.7%, p=0.029), higher log ESR (2.44 vs 2.13, p=0.003) and log CRP (1.63 vs 1.31, p=0.002), and shorter disease duration (mean 8.7 vs 11.2 years, p=0.001). Those with moderate to high disease activity were more likely to be prescribed prednisone (13% vs 4.5%, p<0.001) and non-biologic DMARDs (63% vs 51%, p=0.002), but were less likely to be prescribed TNF inhibitors (57% vs 66%, p=0.015). Mean BMI in moderate to high and low groups were 31.7kg/m2 and 30.6kg/m2, respectively, p=0.02. There were no differences between age, rate of DM, frequency of cholesterol lowering medications, and fish oil supplementation. Moderate to high disease activity was associated with higher odds of TC>200 mg/dl, OR 1.6 (1.1, 2.2 95%CI), p=0.010, and higher odds of TG>150 mg/dl, OR 1.6 (1.2, 2.3 95% CI), p=0.005. Enthesitis/dactylitis was positively associated with TC>200 mg/dl, OR 1.6 (1.1, 2.5), p=0.02. There was no significant association found between disease activity and other lipid measures in the moderate to high disease vs low disease groups. Conclusions Moderate to high disease activity in PsA is associated with increased levels of total cholesterol and triglycerides, suggesting a commonality between PsA disease mechanisms and lipid metabolism that deserves further exploration. The implications of this association for cardiovascular disease in PsA need to be studied further. Di...

2016-12-23T18:47:23