Metabolic syndrome and its components among rheumatoid arthritis patients: A comprehensive updated systematic review and meta-analysis

Abstract

BackgroundEstimating the current global prevalence of metabolic syndrome (MetS), and its components, among rheumatoid arthritis (RA) patients is necessary in order to formulate preventative strategies and to ensure there are adequate community resources available for these patients. Furthermore, the association between RA and MetS is controversial and has not previously been comprehensively assessed. Therefore, the present study aimed to: 1) determine the prevalence of MetS, and its components, among RA patients across the world 2) update the odds ratio of MetS in RA patients, compared to healthy controls, using a comprehensive systematic review and meta-analysis.MethodsInternational databases, including: the Web of Science, PubMed, Scopus, Embase, CINAHL and other relevant databases were searched to identify English language articles which reported the prevalence and risk of MetS in RA patients between January 2000 and August 2016. The meta-analysis only included studies which clearly described the time and location of the study, utilised adequate sampling strategies, and appropriate statistical analyses.ResultsThe meta-analyses of prevalence (70 studies [n = 12612]) and risk (43 studies [n = 35220]) of MetS in RA patients were undertaken separately. The overall pooled prevalence of MetS was 30.65% (95% CI: 27.87–33.43), but this varied from 14.32% (95% CI: 10.59–18.05) to 37.83% (95% CI: 31.05–44.61), based upon the diagnostic criteria used. The prevalence of MetS also varied slightly between males (31.94%, 95% CI: 24.37–39.51) and females (33.03%, 95% CI: 28.09–37.97), but this was not statistically significant. The overall pooled odds ratio (OR) of MetS in RA patients, compared to healthy controls, was 1.44 (95% CI: 1.20–1.74), but this ranged from 0.70 (95% CI: 0.27–1.76) to 4.09 (95% CI: 2.03–8.25), depending on the criteria used. The mean age and diagnostic criteria of MetS were identified as sources of heterogeneity in the estimated odds ratios between studies (P<0.05).ConclusionsAccording to the high prevalence of MetS in RA patients, and high risk of MetS, measuring metabolic syndrome in RA patients is strongly recommended. Furthermore, as high waist circumference (WC) is the most common metabolic syndrome component, more attention must be paid to nutrition and weight loss among those with RA.

Prevalence and Characteristics of Metabolic Syndrome Differ in Men and Women with Early Rheumatoid Arthritis

“…It is reassuring that our MetS prevalence estimate of 31% is in keeping with other published reports. A meta‐analysis showed pooled prevalence of 30.6% across 70 studies, although it was not restricted to ERA subjects . In this same paper, the MetS prevalence varied between men (32%, 95% CI: 24.37‐39.51) and women (33%, 95% CI: 28.09‐37.97) but was not statistically significant, whereas our findings revealed a significantly higher prevalence in men (42%) compared with women (26%) .…”

“…As cited, this variability stems from the different MetS definitions available, cohort characteristics, and geographic differences. Therefore, the findings from this North American population may not be generalizable to other early RA cohorts .…”

“…Metabolic syndrome (MetS) is a clustering of CVD risk factors (hypertension, dyslipidemia, obesity, and impaired glucose tolerance [IGT]) that, when combined, substantially increases the risk of CVD morbidity and mortality . MetS is disproportionately higher in established RA compared with the general population; it is often characterized by other biochemical abnormalities (eg, renal dysfunction), high disease activity, and has been negatively associated with certain therapies (eg, corticosteroids) and favorably associated with others (methotrexate) . However, a wide variation in the prevalence of MetS in RA has been reported in the literature.…”

“…However, a wide variation in the prevalence of MetS in RA has been reported in the literature. This may be explained by differences in the MetS definition used, demographics, and disease course (early RA [ERA] versus established RA) .…”

“…In addition, CVD risk in women with MetS may actually exceed that of men with MetS . In RA, the majority of studies has not found significant differences in MetS prevalence between men and women . These have largely focused on patients with established RA, and results may not be generalizable to ERA where initial disease activity, RA management algorithms, and screening/management of comorbidity may be different .…”