MTX More than just an anti-inflammatory effect? | Arthritis Information

 

 

Introduction

The metabolic syndrome (MetS) may contribute to the excess cardiovascular burden observed in rheumatoid arthritis (RA). The prevalence and associations of the MetS in RA remain uncertain: systemic inflammation and anti-rheumatic therapy may contribute. Methotrexate (MTX) use has recently been linked to a reduced presence of MetS, via an assumed generic anti-inflammatory mechanism. We aimed to: assess the prevalence of the MetS in RA; identify factors that associate with its presence; and assess their interaction with the potential influence of MTX.

Methods

MetS prevalence was assessed cross-sectionally in 400 RA patients, using five MetS definitions (National Cholesterol Education Programme 2004 and 2001, International Diabetes Federation, World Health Organisation and European study Group for Insulin Resistance). Logistic regression was used to identify independent predictors of the MetS. Further analysis established the nature of the association between MTX and the MetS.

Results

MetS prevalence rates varied from 12.1% to 45.3% in RA according to the definition used. Older age and higher HAQ scores associated with the presence of the MetS. MTX use, but not other disease modifying anti-rheumatic drugs (DMARDs) or glucocorticoids, associated with significantly reduced chance of having the MetS in RA (OR = 0.517, CI 0.33 to 0.81, P=0.004)

Conclusions

The prevalence of the MetS in RA varies according to the definition used. MTX therapy, unlike other DMARDs or glucocorticoids, independently associates with a reduced propensity to MetS, suggesting a drug-specific mechanism, and makes MTX a good first line DMARD in RA patients at high risk of developing the MetS, particularly those aged over 60 years.

 

http://arthritis-research.com/content/11/4/R110

[quote]The factors found to associate independently with the metabolic syndrome in RA
included older age, higher HAQ scores, and less methotrexate usage. The association
with older age is not surprising, as in the general population the MetS has been shown
to affect primarily older subjects, as a consequence of age related modification of
some of its components [41]. Higher HAQ scores are also likely to associate with the
MetS in RA, as patients with more severe disabling disease are likely to lead a less
active lifestyle, resulting in increased obesity and alterations in the lipid profile...[/quote]
A fascinating article. I have book marked the .pdf file for further study, but was struck by the above excerpt. One more reason to keep moving and to establish a regular, consistent pattern of exercise.

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