title: Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort.
abstract: BACKGROUND
  The metabolic syndrome (MetS) may contribute to the increased cardiovascular risk in systemic lupus erythematosus (SLE). We examined the association between MetS and disease activity, disease phenotype and corticosteroid exposure over time in patients with SLE.
  
  
  METHODS
  Recently diagnosed (<15 months) patients with SLE from 30 centres across 11 countries were enrolled into the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort from 2000 onwards. Baseline and annual assessments recorded clinical, laboratory and therapeutic data. A longitudinal analysis of factors associated with MetS in the first 2 years of follow-up was performed using random effects logistic regression.
  
  
  RESULTS
  We studied 1150 patients with a mean (SD) age of 34.9 (13.6) years and disease duration at enrolment of 24.2 (18.0) weeks. In those with complete data, MetS prevalence was 38.2% at enrolment, 34.8% at year 1 and 35.4% at year 2. In a multivariable random effects model that included data from all visits, prior MetS status, baseline renal disease, SLICC Damage Index >1, higher disease activity, increasing age and Hispanic or Black African race/ethnicity were independently associated with MetS over the first 2 years of follow-up in the cohort.
  
  
  CONCLUSIONS
  MetS is a persistent phenotype in a significant proportion of patients with SLE. Renal lupus, active inflammatory disease and damage are SLE-related factors that drive MetS development while antimalarial agents appear to be protective from early in the disease course.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Toronto, Ontario, Canada.
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authors.initials: B
authors.lastname: Parker
authors.affiliation: Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Urowitz
authors.affiliation: Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Toronto, Ontario, Canada.
authors.forename: Mark
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authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
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authors.lastname: Donn
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
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authors.affiliation: Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
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authors.affiliation: Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
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authors.affiliation: Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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authors.affiliation: Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Daniel J
authors.initials: DJ
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authors.affiliation: Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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authors.initials: AE
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authors.affiliation: Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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authors.lastname: Bernatsky
authors.affiliation: Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA.
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authors.initials: EM
authors.lastname: Ginzler
authors.affiliation: Centre for Rheumatology Research, University College, London, UK.
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authors.affiliation: Centre for Rheumatology Research, University College, London, UK.
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authors.affiliation: Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.
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authors.initials: JT
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authors.affiliation: Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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authors.initials: GS
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authors.affiliation: Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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authors.initials: BJ
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authors.affiliation: Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada.
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authors.initials: PR
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authors.affiliation: Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
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authors.initials: JG
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authors.affiliation: Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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authors.affiliation: Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland.
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authors.affiliation: Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
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authors.lastname: Dooley
authors.affiliation: Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
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authors.affiliation: Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK.
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authors.affiliation: Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Rosalind
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authors.lastname: Ramsey-Goldman
authors.affiliation: Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK.
authors.forename: Asad A
authors.initials: AA
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authors.affiliation: Department of Rheumatology, University Hospital Lund, Lund, Sweden.
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authors.initials: GK
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authors.affiliation: Department of Rheumatology, University Hospital Lund, Lund, Sweden.
authors.forename: Ola
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authors.affiliation: Feinstein Institute for Medical Research, Manhasset, New York, USA.
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authors.affiliation: Feinstein Institute for Medical Research, Manhasset, New York, USA.
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authors.affiliation: Department of Autoimmune Diseases, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Hospital Clínic, Barcelona, Spain.
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authors.lastname: Ramos-Casals
authors.affiliation: Unit for Clinical Therapy Research (ClinTRID), The Karolinska Institute, Stockholm, Sweden.
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authors.initials: RF
authors.lastname: van Vollenhoven
authors.affiliation: UCSD School of Medicine, La Jolla, California, USA.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Kalunian
authors.affiliation: Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Irastorza
authors.affiliation: Emory University, Atlanta, Georgia, USA.
authors.forename: S Sam
authors.initials: SS
authors.lastname: Lim
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Kamen
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Peschken
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Inanc
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Toronto, Ontario, Canada.
authors.forename: Ian N
authors.initials: IN
authors.lastname: Bruce
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology*; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D010641:Phenotype; D015995:Prevalence; D055815:Young Adult
keywords: Cardiovascular Disease; Inflammation; Systemic Lupus Erythematosus