title: Prevalence, incidence and characteristics of the metabolic syndrome (MetS) in a cohort of Mexican Mestizo early rheumatoid arthritis patients treated with conventional disease modifying anti-rheumatic drugs: the complex relationship between MetS and disease activity.
abstract: BACKGROUND
  A higher prevalence of metabolic syndrome (MetS) has been described in rheumatoid arthritis (RA), along with an association with disease activity. Objectives were to describe prevalence of MetS at RA diagnosis in a cohort of Mexican Mestizo early RA patients, and to define a causal association between MetS and disease activity.
  
  
  METHODS
  The study population was a prospective cohort. At baseline and at fixed 6-months-intervals, patients had medical evaluations, fasting serum glucose, triglycerides, high-density lipoprotein cholesterol and acute reactant-phase determinations. MetS was defined according to international criteria and body mass index (BMI)≥30 kg/m2 was used as a surrogate of the waist circumference. The study was approved by the internal review board. Appropriated statistics and Cox regression analysis were used. All statistical tests were two-sided and evaluated at the 0.05 significance level.
  
  
  RESULTS
  Up to March 2014, data from 160 patients were analyzed. At baseline, they were more frequently middle-aged females and had moderate to high disease activity. Prevalence of MetS varied from 11.3% to 17.5% in patients and was lower to that from matched controls (versus 26.3% to 30%, P≤0.01). Up to last follow-up, 39 patients (34.5%) developed incidental MetS. In the Cox regression analysis, cumulative disease activity score (DAS) 28 (odds ratio (OR): 1.81, 95% confidence interval (CI): 1.346 to 2.433, P=0.000) and baseline BMI (OR: 1.13, 96% CI: 1.035 to 1.236, P=0.007) were the only predictors for incidental MetS. RA patients with incidental MetS accumulated more disease activity and had less frequent remission than their counterparts. Logistic regression analysis showed that incidental MetS (OR: 0.2, 95% CI: 0.01 to 0.99, P=0.052) and baseline DAS28 (OR: 0.4, 95% CI: 0.2 to 0.9, P=0.02) were the only predictors for achieving or maintaining sustained (≥6 months) remission.
  
  
  CONCLUSIONS
  MetS prevalence in a cohort of early RA patients was lower than that from matched controls. Cumulative disease activity and higher BMI were risk factors for incidental Mets; higher baseline disease activity and incidental MetS prevented sustained remission. In addition to disease activity, MetS needs to be controlled to impact disease outcomes.
authors.affiliation: Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México. fepa_an@hotmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Parra-Salcedo
authors.affiliation: Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México. irazucy@yahoo.com.mx.
authors.forename: Irazú
authors.initials: I
authors.lastname: Contreras-Yáñez
authors.affiliation: Department of Metabolism and Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México. drdanielelias@outlook.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Elías-López
authors.affiliation: Department of Metabolism and Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México. caguilarsalinas@yahoo.com.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Aguilar-Salinas
authors.affiliation: Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México. virtichu@gmail.com.
authors.forename: Virginia
authors.initials: V
authors.lastname: Pascual-Ramos
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000208:ethnology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D008297:Male; D024821:Metabolic Syndrome / Q000188:drug therapy / Q000208:ethnology*; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents