Prevalencia de dislipidemia en artritis temprana y su relación con actividad inflamatoria
DOI:
https://doi.org/10.31053/1853.0605.v74.n3.16623Palabras clave:
artritis, dislipidemiasResumen
El riesgo cardiovascular está aumentado en pacientes con Artritis Reumatoidea establecida, con aumento de la morbimortalidad cardiovascular, inclusive tempranamente y puede ser expresión subclínica de la enfermedad. Pocos estudios han evaluado el perfil lipídico en artritis temprana (AT). OBJETIVOS: Determinar la prevalencia y el tipo de alteración del perfil lipídico en pacientes con AT y su asociación con la actividad de la enfermedad (AE). MATERIAL Y MÉTODOS: Se estudiaron pacientes con diagnóstico de AT comparados con un grupo control, apareados por sexo, edad y factores de riesgo cardiovascular, asistidos de forma consecutiva desde enero de 2011 a mayo de 2013 en el Hospital Córdoba. Se recolectaron datos demográficos, perfil lipídico y actividad de la enfermedad (AE) por Disease Activity Score (DAS 28). Se comparó el nivel de lípidos en ambos grupos y entre pacientes con artritis según el nivel de AE, clasificándolos en Baja AE y Mediana / Alta AE. P menor a 0.05 fue considerada significativa. RESULTADOS: El número de pacientes con Artritis temprana fue de 31, con una media de edad de 42.3 años, 87% sexo femenino y el nivel de Colesterol Total promedio fue de 191.9 mg/dl, HDL 54, LDL 115.8, Triglicéridos 117,6, mientras que el grupo control fue de 31 pacientes con una media de edad de 42.7 años, con nivel promedio de Colesterol 198.7 mg/dl, HDL 56.9, LDL 122.6, Triglicéridos 99.6 (p=NS, para todas las determinaciones). En cuanto a la actividad de la enfermedad, en el grupo de Baja AE los niveles de Colesterol fueron 196.3, LDL 115.8, HDL 62 y triglicéridos 95.17 y en el grupo moderada y alta AE, Colesterol 190,1 LDL 115, 8, HDL 52 y triglicéridos 122,9 (p NS para todas las comparaciones)
CONCLUSIONES: El perfil lipídico fue normal y no se encontró asociado a la AE en pacientes con AT.
Descargas
Citas
(1) Toms T, Panoulas V., Kitas G. Dyslipidaemia in Rheumatological Autoimmune Diseases The Open Cardiovascular Medicine Journal, 2011, 5, 64-75 1874-1924/11 2011
(2) Van Doornum S, McColl G, Wicks I. Accelerated Atherosclerosis An Extraarticular Feature of Rheumatoid Arthritis? ARTHRITIS & RHEUMATISM. 2002;46(4): 862–873
(3) Sandoo A, Veldhuijzen van Zanten J, Metsios G, Carroll D, Kitas G. Vascular function and morphology in rheumatoid arthritis: a systematic review. Rheumatology. 2011; 50:2125–2139.
(4) Harris E. Clinical features of rheumatoid arthritis. In: Harris E, Budd R, Firestein G, Genovese M, Sergent J, Ruddy S ,et al, editors Kelley’s textbook of rheumatology.7th ed.Philadelphia: Elsevier Saunders; 2005:1243-78
(5) Nurmohamed MT. Atherogenic lipid profile and its management in patients with rheumatoid arthritis. Vasc Health Risk Manag 2007; 3(6):845–852
(6) Turesson C, O’Fallon W, Crowson C, Gabriel S, Matteson E. Occurrence of extraarticulardiseasemanifestationsisassociatedwithexcessmortality in a community based cohort of patients with rheumatoid arthritis. JRheumatol. 2002; 29:62-7
(7) Nakken B, Szodoray P. Accelerated atherosclerosis in rheumatoid arthritis: rationale for mannose- binding lectins. J Rheumatol 2010; 37(3):482-484.
(8) Maradit-Kremers H, Crowson C, Nicola P, Ballman K, Roger V, Jacobsen S et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis and Rheumatism. 2005; 52(2):402–411
(9) Meune C, Touz´e E, Trinquart L, Allanore Y. High risk of clinical cardiovascular events in rheumatoid arthritis: levels of associations of myocardial infarction and stroke through a systematic review and meta-analysis. Archives of Cardiovascular Diseases. 2010; 103(4): 253–261
(10) Cavagna L, Boffini N, Cagnotto G, Inverardi F, Grosso V, Caporali R. Atherosclerosis and Rheumatoid Arthritis: More Than a Simple Association. Mediators of Inflammation. 2012; 2012:1-9.
(11) Naz S, Symmons D. Mortality in established rheumatoid arthritis. Best Pract Res ClinRheumatol 2007; 21:871-83
(12) Roman M, Salmon J. Cardiovascular Manifestations of rheumatologic Diseases. Circulation. 2007; 116: 2346-2355
(13) Solomon D, Goodson N, Katz J, Weinblatt M, Avorn J, Setoguchi S, et al. Patterns of cardiovascular risk in rheumatoid arthritis Ann Rheum Dis 2006; 65:1608–1612.
(14) Rindfleisch J, Muller D. Diagnosis and management of rheumatoid arthritis. Am Fam Physician 2005; 72(6):1037-1047.
(15) Gonzalez-Juanatey C, Llorca J, Testa A, Revuelta J, Garcia-Porrua C, Gonzalez-Gay M. Increased prevalence of severe subclinical atherosclerotic findings in long-term treated rheumatoid arthritis patients without clinically evident atherosclerotic disease. Medicine (Baltimore) 2003; 82:407-13
(16) Stavropoulos-Kalinoglou A, Metsios G, Panoulas V et al. Associations of obesity with modifiable risk factors for the development of cardiovascular disease in patients with rheumatoid arthritis. Annals of the Rheumatic Diseases. 2009; 68(2):242–245.
(17) Panoulas V, Metsios G, Pace A et al. Hypertension in rheumatoid arthritis. Rheumatology. 2008;47(9):1286– 1298
(18) Pereira R, de Carvalho J, Bonf´a E. Metabolic syndrome in rheumatological diseases. Autoimmunity Reviews 2009;8(5): 415–419.
(19) Kitas G, Gabriel S. Cardiovascular disease in rheumatoid arthritis: state of the art and future perspectives. Annals of the Rheumatic Diseases.2011; 70:8–14.
(20) Myasoedova E, Crowson C, Kremers H, Roger V, Fitz-Gibbon P, Therneau T et al. Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann Rheum Dis 2011; 70:482-487.
(21) Ku I, Imboden J, Hsue P, Ganz P. Rheumatoid arthritis—a model of systemic inflammation driving atherosclerosis. Circulation Journal. 2009; 73(6):977– 985.
(22) Gonzalez-Gay M, Gonzalez-Juanatey C, Martin J. Rheumatoid arthritis: a disease associated with accelerated atherogenesis. Seminars in Arthritis and Rheumatism. 2005; 35(1):8–17.
(23) Myasoedova E, Gabriel S. Cardiovascular disease in rheumatoid arthritis: a step forward. Current Opinion in Rheumatology. 2010; 22 (3):342–347
(24) Kim S, Lee C, Lee E, Park S, Cho Y, Yoo B et al. Serum oxidized low density lipoproteins in rheumatoid arthritis. Rheumatology International. 2004;24(4):230–233
(25) Del Rincon I, Williams K, Stern M, Freeman G, Escalante A. High incidence of cardiovascular events in rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 2001; 44:2737-45.
(26) Mirjafari H, Al-Husain A, Bruce I. Cardiovascular risk factors in inflammatory arthritis. Current Opinion in Lipidology. 2011; 22(4):296–301.
(27) Szekanecz Z, Kerekes G, Dér H, Sándor Z, Szabó Z, Végvári A, et al. Accelerated aterosclerosis in rheumatoidarthritis. AnnNYAcadSci 2007; 1108:349-58.
(28) Snow M, Mikuls T. Rheumatoid arthritis and cardiovascular disease: the role of systemic inflammation and evolving strategies of prevention. CurrOpinRheumatol 2005;17:234-41.
(29) Toms T, Panoulas V, Douglas K, Nightingale P, Smith J, Griffiths H et al. Are lipid ratios less susceptible to change with systemic inflammation than individual lipid components in patients with rheumatoid arthritis? Angiology 2011; 62(2):167-175
(30) Dessein P, Joffe B, Stanwix A, Botha A, Moomal Z. The acute phase response does not fully predict the presence of insulin resistance and dyslipidaemia in inflammatory arthritis. J Rheumatol 2002; 29: 462-6
(31) Peters MJ, Vis M, van Halm VP, et al. Changes in lipid profile during infliximab and corticosteroid treatment in rheumatoid arthritis. Ann Rheum Dis 2007; 66: 958-61.
(32) Choy E, Sattar N. Interpreting lipid levels in the context of high-grade inflammatory states with a focus on rheumatoid arthritis: a challenge to conventional cardiovascular risk actions. Ann Rheum Dis 2009;68:460-46
(33) Situnayake R, Kitas G. Dyslipidemia and rheumatoid arthritis. Ann Rheum Dis 1997; 56:341-342
(34) Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-72.
(35) American Diabetes Association. Standards of medical care in diabetes—2011: Position Statement Diabetes Care. 2011; 34(1):S11-61.
(36) Ustrell-Roig X et al. Ictus. Diagnóstico y tratamiento de las enfermedades cerebrovasculares Rev Esp Cardiol. 2007;60(7):753-69
(37) Thygesen et al. JACC Universal Definition of Myocardial Infarction. ESC/ACCF/AHA/WHF Expert Consensus Document 2007;50 (22):2173–95
(38) Jimenez Ruiz CA, et al. Recomendaciones en el abordaje diagnóstico y terapéutico del tabaquismo. Documento de consenso Arch Bronconeumol 2003;39(1):35-41
(39) Grundy S, Cleeman J, Bairey Merz H, Bryan Brewer C, Clark L, Hunninghake D et al. Implications of recent clinical trials for the National Cholesterol Education Program ATP III guidelines. Circulation 2004; 110(2):227-239
(40) World Health Organization. Obesity. 2008 [Accessed October 22, 2009]. Available at: http://www.who.int/topics/obesity/en/
(41) Aletaha D, Ward M M, Machold KP, NellVP. Remission and active disease in rheumatoid arthritis: defining criteria for disease activity states. Arthritis Rheum 2005; 52:2625-2636
(42) Anderson J, Zimmerman L, Caplan L, Michaud K. Measures of Rheumatoid Arthritis Disease Activity Arthritis Care & Research, 2011; 63(S11): S14–S36
(43) Georgiadis et al. Atherogenic lipid profile is a feature characteristic of patients with early rheumatoid arthritis: effect of early treatment – a prospective, controlled study. Arthritis Research & Therapy 2006;8:R82
(44) Dessein PH, Stanwix AE, Joffe BI: Cardiovascular risk in rheumatoidarthritis versus osteoarthritis: acute phase response related decreased insulin sensitivity and high-density lipoproteincholesterol as well as clustering of metabolic syndrome features in rheumatoid arthritis. Arthritis Res 2002;4:R5.
(45) Munro R, Morrison E, McDonald AG, Hunter JA, Madhok R, Capell HA: Effect of disease modifying agents on the lipid profiles of patients with rheumatoid arthritis. Ann Rheum Dis 1997;56:374-377.
(46) Full, L. et al .The inextricable link between atherosclerosis and prototypical inflammatory diseases rheumatoid arthritis and systemic lupus erythematosus. Arthritis Research & Therapy 2009;11:217
(47) Galindo J. et al. Dyslipidemia in patients with rheumatoid arthritis attended at a general hospital. Rev Med Hered 2011;22:47-53
(48) Boers M, Nurmohamed M, Doelman C, Lard L, Verhoeven A, Voskuyl A et al. Influence of glucocorticoid and disease activity on total and high density lipoprotein cholesterol in patients with rheumatoid arthritis. Ann Rheum Dis 2003;62:842-845
(49) Park Y, Lee S, Lee W, Suh C, Lee C, Lee C et al. Lipid profiles in untreated patients with rheumatoid arthritis. J Rheumatol 1999;26:1701-1704
(50) Vibhuti Singh.Low high-density lipoprotein cholesterol: current status and future strategies for management Vascular Health and Risk Management 2010;6: 979–996
(51) Park Y.; Choi, H et al. Effects of antirheumatic therapy on serum lipid levels in patients with rheumatoid arthritis: a prospective study The American Journal of Medicine 2002; 113(3):188-193
(52) Lorber M, Aviram M, Linn S, Scharf Y, Brook JG: Hypocholesterolaemia and abnormal high-density lipoprotein in rheumatoid arthritis. Br J Rheumatol1985; 24:250-255.
(53) Frati E, Castagna ML, Bacarelli MR, Fioravanti A, Giordano N, Taddeo A et al. Plasma levels of apolipoprotein and HDLcholesterol in patients with rheumatoid arthritis. Boll SocItalBiolSper1984;60:1791-1796
(54) Choi H, Seerger J. Lipid Profiles Among US Elderly with Untreated Rheumatoid Arthritis — The Third National Health and Nutrition Examination Survey. (NHANES III) J Rheumatol 2005;32:2311-6
(55) Naranjo, A et al. Research article Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study, Arthritis Research & Therapy 2008, 10:R30
(56) van Halm V, Nielen M, Nurmohamed M, van Schaardenburg D, Reesink H., Voskuyl E. et al. Lipids and inflammation: serial measurements of the lipid profile of blood donors who later developed rheumatoid arthritis. Ann Rheum Dis 2007; 66:184–188.
(57) Myasoedova E. et al. Total Cholesterol and LDL levels decrease before rheumatoid arthritis Ann Rheum Dis. 2010 July ; 69(7): 1310–1314.
(58) Svenson KLG, Lithell H, Hällgren, et al. Serum lipoprotein in activerheumatoid arthritis and other chronic infl ammatory arthritides.I Relativity to infl ammatory activity. Arch Intern Med,1987;147:1912–16
(59) White D, Fayez S, Doube A. Atherogenic lipid profi les in rheumatoid arthritis. N Z Med 2006; 119:U2125
Descargas
Archivos adicionales
Publicado
Cómo citar
Número
Sección
Licencia
La Revista de la Facultad de Ciencias Médicas de Córdoba (RFCM) adhiere a la política de Acceso Abierto y no cobra cargos a los autores para publicar, ni tampoco a lectores para acceder a los artículos publicados.
