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Metabolic syndrome in systemic lupus erythematosus patients

Relationship to disease activity and neuropsychiatric lupus

Metabolisches Syndrom bei Patienten mit systemischem Lupus erythematodes

Beziehung zu Krankheitsaktivität und neuropsychiatrischem Lupus

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Abstract

Objective

The study aims to evaluate the presence of metabolic syndrome (MetS) among Egyptian systemic lupus erythematosus (SLE) patients. Additionally, we intended to determine the association of MetS with disease activity, clinical and laboratory features.

Patients and methods

This cross-sectional study included adult SLE patients diagnosed and followed in rheumatology outpatient clinics. The demographic data, clinical and laboratory parameters were assessed for all patients. Disease activity was measured using SLE Disease Activity Index (SLEDAI-2k). Patients were diagnosed to have MetS according to The National Cholesterol Education Program Adult Treatment Panel III (NCEP). The characteristics of SLE patients and their disease status were compared between those with and without MetS.

Results

A total of 74 SLE patients were included; mean age was 32.1 ± 10.9 years and 87.8% were females. Twenty-five (33.8%) SLE patients had neuropsychiatric lupus (NPSLE), with headache the most common manifestation. MetS was diagnosed in 45.9% of the SLE group. Patients with MetS had significantly older age, delayed age of diagnosis and higher SLEDAI-2k scores (p = 0.015, p = 0.014 and p = 0.019, respectively) compared to those without MetS. NPSLE was significantly correlated with MetS (r = 0.32, p = 0.006) and in particular with higher central obesity (r = 0.43, p < 0.001). In the multivariate analysis, NPSLE remained independently associated with MetS (OR = 4.9, p = 0.004, 95% CI = 1.7–14.4).

Conclusion

Metabolic syndrome is present in a significant proportion of Egyptian patients with adult SLE. Delayed disease diagnosis and higher disease activity are SLE-related factors that may contribute to increase the risk of MetS. Data suggest that neuropsychiatric lupus may underlie some of the increased risk for MetS and central obesity.

Zusammenfassung

Ziel

Das Ziel dieser Studie ist es, die Häufigkeit des metabolischen Syndroms (MetS) bei Patienten mit systemischem Lupus erythematodes (SLE) in Ägypten zu untersuchen. Darüber hinaus zielt diese Studie auch darauf, die Assoziation von MetS mit Krankheitsaktivität, klinischen Eigenschaften und Laborparametern festzustellen.

Patienten und Methoden

Diese Querschnittsstudie umfasste erwachsene SLE-Patienten, deren Diagnostik und Beobachtung in Rheumatologieambulanzen erfolgte. Die demographischen Daten, klinische und Laborparameter wurden für alle Patienten bewertet. Die Krankheitsaktivität wurde unter Verwendung des SLE-Krankheitsaktivitätsindex (SLEDAI-2k) gemessen. Bei den Patienten wurde MetS nach dem National Cholesterol Education Program Adult Treatment Panel III (NCEP, nationales Programm zur Patientenedukation über Cholesterin bei der Therapie von Erwachsenen) diagnostiziert. Die Charakteristika der SLE-Patienten und ihr Erkrankungsstatus mit und ohne MetS wurden verglichen.

Ergebnisse

Es wurden insgesamt 74 SLE-Patienten in diese Studie eingeschlossen, das durchschnittliche Alter der Patienten lag bei 32,1 ± 10,9 Jahre, weiblich waren 87,8 %. Eine neuropsychiatrische Form des Lupus (NPSLE) wiesen 25 (33,8 %) der SLE-Patienten auf, dabei waren Kopfschmerzen das häufigste Symptom. Ein MetS wurde in 45,9 % der Fälle von SLE diagnostiziert. Patienten mit MetS zeigten ein signifikant höheres Alter, ein verzögertes Diagnosealter und höhere SLEDAI-2k-Werte (p = 0,015; p = 0,014; p = 0,019) im Vergleich zu den Patienten ohne MetS. Ein NPSLE war signifikant mit dem MetS korreliert (r = 0,32; p = 0,006) und insbesondere mit einem höheren Grad der zentralen Adipositas (r = 0,43; p < 0,001). In der multivariaten Analyse blieb ein NPSLE in unabhängiger Weise mit einem MetS assoziiert (Odds Ratio, OR = 4,9; p = 0,004; 95 %-Konfidenzintervall, 95%-KI = 1,7–14,4).

Schlussfolgerung

Bei einer signifikanten Anzahl der ägyptischen Patienten mit SLE ist ein MetS vorhanden. Ein verzögerter Diagnosebeginn und eine höhere Krankheitsaktivität sind SLE-bedingte Faktoren, die das Risiko für ein MetS erhöhen. Die Daten legen nahe, dass ein NPSLE dem erhöhten Risiko für ein MetS und zentrale Fettleibigkeit zugrunde liegen könnte.

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Funding

N. Hammam received funding grant from faculty of medicine, Assiut University.

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Authors and Affiliations

  1. Rheumatology and Rehabilitation Department, Faculty of Medicine, Assuit University, Assiut, Egypt

    N. Hammam M.D., Ph.D. & A. A. A. Mohamed

  2. University of Alberta, Corbett Hall, 8205 114 Street, T6G2G4, Edmonton, Alberta, Canada

    N. Hammam M.D., Ph.D.

  3. Department of Rheumatology and Rehabilitation, Faculty of Medicine, Suez University, Suez, Egypt

    S. M. Rashad

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  1. N. Hammam M.D., Ph.D.
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  3. A. A. A. Mohamed
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Correspondence to N. Hammam M.D., Ph.D..

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Conflict of interest

N. Hammam, S. M. Rashad and A. A. A. Mohamed declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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U. Müller-Ladner, Bad Nauheim

U. Lange, Bad Nauheim

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Hammam, N., Rashad, S.M. & Mohamed, A.A.A. Metabolic syndrome in systemic lupus erythematosus patients. Z Rheumatol 77, 938–945 (2018). https://doi.org/10.1007/s00393-018-0447-0

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