Rheumatology International

, Volume 37, Issue 1, pp 21–27 | Cite as

The metabolic profile in early rheumatoid arthritis: a high prevalence of metabolic obesity

  • Raili MüllerEmail author
  • Mart Kull
  • Kaja Põlluste
  • Annika Aart
  • Triin Eglit
  • Margus Lember
  • Riina Kallikorm
Observational Research


The aim of the study was to compare the prevalence of metabolic syndrome (MetS) in early RA patients with age–gender-matched population controls focusing on the presence of MetS in different weight categories. The study group consisted of 91 consecutive patients with early RA and 273 age- and gender-matched controls subjects. MetS was diagnosed according to the National Cholesterol Education Program (NCEP-ATP III) criteria. Mean age in both groups was 52 years, and 72.5 % were female. The prevalence of MetS did not differ between the two groups (35.2 % in RA, 34.1 % in control group). Mean systolic blood pressure in the RA group was 137 mmHg, in control group 131 mmHg, P = 0.01, and diastolic blood pressure 85 versus 81 mmHg, respectively (P < 0.01). We found that 20 of 65 (30.8 %) of RA patients compared to 80 of 152 (52.6 %) of the control subjects with elevated blood pressure received antihypertensive treatment (P < 0.01). When comparing subgroups with normal BMI, the odds of having MetS (being metabolically obese) were higher among early RA subjects (OR 5.6, CI 1.3–23.8). Of the individual components of metabolic syndrome, we found increased prevalence of hypertension (OR 2.8, CI 1.3–6.0) and hyperglycemia (OR 2.9, CI 1.0–8.0) in the RA group. Recognition of abnormal metabolic status among normal-weight RA patients who have not yet developed CVD could provide a valuable opportunity for preventative intervention.


Rheumatoid arthritis Early arthritis Metabolic syndrome Metabolic obesity 



This study was funded by the European Regional Development Fund through the Estonian Research Council’s health research promotion program TerVE (Grant Number 3.2.1002.11-0002) and by the Institutional Research Grant IUT 2-8.

Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflict of interest.

Ethical approval

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


  1. 1.
    Dadoun S, Zeboulon-Ktorza N, Combescure C et al (2013) Mortality in rheumatoid arthritis over the last fifty years: systematic review and meta-analysis. Jt Bone Spine Rev Rhum 80:29–33. doi: 10.1016/j.jbspin.2012.02.005 CrossRefGoogle Scholar
  2. 2.
    Puttevils D, De Vusser P, Geusens P, Dens J (2014) Increased cardiovascular risk in patients with rheumatoid arthritis: an overview. Acta Cardiol 69:111–118PubMedGoogle Scholar
  3. 3.
    Peters MJL, Symmons DPM, McCarey D et al (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69:325–331CrossRefPubMedGoogle Scholar
  4. 4.
    Meune C, Touzé E, Trinquart L, Allanore Y (2009) Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology 48:1309–1313. doi: 10.1093/rheumatology/kep252 CrossRefPubMedGoogle Scholar
  5. 5.
    Levi F, Chatenoud L, Bertuccio P et al (2009) Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update. Eur J Cardiovasc Prev Rehabil 16:333–350. doi: 10.1097/HJR.0b013e328325d67d CrossRefPubMedGoogle Scholar
  6. 6.
    Nichols M, Townsend N, Scarborough P, Rayner M (2013) Trends in age-specific coronary heart disease mortality in the European Union over three decades: 1980–2009. Eur Heart J. doi: 10.1093/eurheartj/eht159 PubMedCentralGoogle Scholar
  7. 7.
    Gonzalez A, Maradit Kremers H, Crowson CS et al (2007) The widening mortality gap between rheumatoid arthritis patients and the general population. Arthritis Rheum 56:3583–3587. doi: 10.1002/art.22979 CrossRefPubMedGoogle Scholar
  8. 8.
    Humphreys JH, Warner A, Chipping J et al (2014) Mortality trends in patients with early rheumatoid arthritis over 20 years: results from the norfolk arthritis register: trends of mortality rates in UK patients with early RA. Arthritis Care Res 66:1296–1301. doi: 10.1002/acr.22296 CrossRefGoogle Scholar
  9. 9.
    Goodson NJ, Wiles NJ, Lunt M et al (2002) Mortality in early inflammatory polyarthritis: cardiovascular mortality is increased in seropositive patients. Arthritis Rheum 46:2010–2019. doi: 10.1002/art.10419 CrossRefPubMedGoogle Scholar
  10. 10.
    Lacaille D, Sayre EC, Abrahamowicz M (2015) Improvement in mortality in RA compared to the general population—closing the mortality gap (abstract). Arthritis Rheumatol 67 (suppl 10)Google Scholar
  11. 11.
    Markusse IM, Dirven L, van Groenendael JH et al (2014) Mortality in a large cohort of patients with early rheumatoid arthritis that were treated-to-target for 10 years (abstract). Arthritis Rheumatol 66 (Suppl 11)Google Scholar
  12. 12.
    Gonzalez A, Maradit Kremers H, Crowson CS et al (2008) Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in non-rheumatoid arthritis patients? Ann Rheum Dis 67:64–69. doi: 10.1136/ard.2006.059980 CrossRefPubMedGoogle Scholar
  13. 13.
    Del Rincón I, Williams K, Stern MP et al (2001) High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 44:2737–2745. doi: 10.1002/1529-0131(200112)44:12<2737::AID-ART460>3.0.CO;2-# CrossRefPubMedGoogle Scholar
  14. 14.
    Ferraz-Amaro I, González-Juanatey C, López-Mejias R et al (2013) Metabolic syndrome in rheumatoid arthritis. Mediat Inflamm. doi: 10.1155/2013/710928 Google Scholar
  15. 15.
    (2002) Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 106:3143–3143Google Scholar
  16. 16.
    Grundy SM, Brewer HB, Cleeman JI et al (2004) Definition of metabolic syndrome report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on scientific issues related to definition. Circulation 109:433–438. doi:  10.1161/01.CIR.0000111245.75752.C6
  17. 17.
    Zhang J, Fu L, Shi J et al (2013) The risk of metabolic syndrome in patients with rheumatoid arthritis: a meta-analysis of observational studies. PLoS One 8:e78151. doi: 10.1371/journal.pone.0078151 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Chung CP, Oeser A, Solus JF et al (2008) Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis. Atherosclerosis 196:756–763. doi: 10.1016/j.atherosclerosis.2007.01.004 CrossRefPubMedGoogle Scholar
  19. 19.
    da Cunha VR, Brenol CV, Brenol JCT et al (2012) Metabolic syndrome prevalence is increased in rheumatoid arthritis patients and is associated with disease activity. Scand J Rheumatol 41:186–191. doi: 10.3109/03009742.2011.626443 CrossRefPubMedGoogle Scholar
  20. 20.
    Crowson CS, Myasoedova E, Davis JM et al (2011) Increased prevalence of metabolic syndrome associated with rheumatoid arthritis in patients without clinical cardiovascular disease. J Rheumatol 38:29–35. doi: 10.3899/jrheum.100346 CrossRefPubMedGoogle Scholar
  21. 21.
    Abourazzak FE, Mansouri S, Najdi A et al (2014) Prevalence of metabolic syndrome in patients with rheumatoid arthritis in Morocco: a cross-sectional study of 179 cases. Clin Rheumatol 33:1549–1555. doi: 10.1007/s10067-014-2570-x CrossRefPubMedGoogle Scholar
  22. 22.
    Kerekes G, Nurmohamed MT, González-Gay MA et al (2014) Rheumatoid arthritis and metabolic syndrome. Nat Rev Rheumatol 10:691–696. doi: 10.1038/nrrheum.2014.121 CrossRefPubMedGoogle Scholar
  23. 23.
    Mok CC, Ko GTC, Ho LY et al (2011) Prevalence of atherosclerotic risk factors and the metabolic syndrome in patients with chronic inflammatory arthritis. Arthritis Care Res 63:195–202. doi: 10.1002/acr.20363 CrossRefGoogle Scholar
  24. 24.
    Karimi M, Mazloomzadeh S, Kafan S, Amirmoghadami H (2011) The frequency of metabolic syndrome in women with rheumatoid arthritis and in controls. Int J Rheum Dis 14:248–254. doi: 10.1111/j.1756-185X.2011.01595.x CrossRefPubMedGoogle Scholar
  25. 25.
    Sahebari M, Goshayeshi L, Mirfeizi Z et al (2011) Investigation of the association between metabolic syndrome and disease activity in rheumatoid arthritis. Sci World J 11:1195–1205. doi: 10.1100/tsw.2011.111 CrossRefGoogle Scholar
  26. 26.
    Šalamon L, Morović-Vergles J, Marasović-Krstulović D et al (2015) Differences in the prevalence and characteristics of metabolic syndrome in rheumatoid arthritis and osteoarthritis: a multicentric study. Rheumatol Int. doi: 10.1007/s00296-015-3307-0 PubMedGoogle Scholar
  27. 27.
    Mathew H, Farr OM, Mantzoros CS (2016) Metabolic health and weight: understanding metabolically unhealthy normal weight or metabolically healthy obese patients. Metabolism 65:73–80. doi: 10.1016/j.metabol.2015.10.019 CrossRefPubMedGoogle Scholar
  28. 28.
    St-Onge M-P, Janssen I, Heymsfield SB (2004) Metabolic syndrome in normal-weight americans new definition of the metabolically obese, normal-weight individual. Diabetes Care 27:2222–2228. doi: 10.2337/diacare.27.9.2222 CrossRefPubMedGoogle Scholar
  29. 29.
    Giles JT, Allison M, Blumenthal RS et al (2010) Abdominal adiposity in rheumatoid arthritis: association with cardiometabolic risk factors and disease characteristics. Arthritis Rheum 62:3173–3182. doi: 10.1002/art.27629 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Elkan A-C, Håkansson N, Frostegård J et al (2009) Rheumatoid cachexia is associated with dyslipidemia and low levels of atheroprotective natural antibodies against phosphorylcholine but not with dietary fat in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 11:R37. doi: 10.1186/ar2643 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Book C, Karlsson MK, Åkesson K, Jacobsson LTH (2009) Early rheumatoid arthritis and body composition. Rheumatology 48:1128–1132. doi: 10.1093/rheumatology/kep165 CrossRefPubMedGoogle Scholar
  32. 32.
    Book C, Karlsson M, Nilsson J-Å et al (2011) Changes in body composition after 2 years with rheumatoid arthritis. Scand J Rheumatol 40:95–100. doi: 10.3109/03009742.2010.507215 CrossRefPubMedGoogle Scholar
  33. 33.
    Wilson PF, D’Agostino RB, Sullivan L et al (2002) Overweight and obesity as determinants of cardiovascular risk: the framingham experience. Arch Intern Med 162:1867–1872. doi: 10.1001/archinte.162.16.1867 CrossRefPubMedGoogle Scholar
  34. 34.
    Escalante A, Haas RW, del Rincón I (2005) Paradoxical effect of body mass index on survival in rheumatoid arthritis: role of comorbidity and systemic inflammation. Arch Intern Med 165:1624–1629. doi: 10.1001/archinte.165.14.1624 CrossRefPubMedGoogle Scholar
  35. 35.
    Kremers HM, Nicola PJ, Crowson CS et al (2004) Prognostic importance of low body mass index in relation to cardiovascular mortality in rheumatoid arthritis. Arthritis Rheum 50:3450–3457. doi: 10.1002/art.20612 CrossRefPubMedGoogle Scholar
  36. 36.
    Dao H-H, Do Q-T, Sakamoto J (2010) Increased frequency of metabolic syndrome among Vietnamese women with early rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 12:R218. doi: 10.1186/ar3203 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Parra-Salcedo F, Contreras-Yáñez I, Elías-López D et al (2015) 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. Arthritis Res Ther 17:34. doi: 10.1186/s13075-015-0549-x CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Eglit T, Rajasalu T, Lember M (2012) Metabolic syndrome in estonia: prevalence and associations with insulin resistance. Int J Endocrinol. doi: 10.1155/2012/951672 PubMedPubMedCentralGoogle Scholar
  39. 39.
    van Gestel AM, Haagsma CJ, van Riel PL (1998) Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum 41:1845–1850. doi: 10.1002/1529-0131(199810)41:10<1845:AID-ART17>3.0.CO;2-K CrossRefPubMedGoogle Scholar
  40. 40.
    World Health Organization (1997) Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity, 3–5 June 1997, WHO/NUT/NCD/98.1. WHO, GenevaGoogle Scholar
  41. 41.
    Eckel N, Mühlenbruch K, Meidtner K et al (2015) Characterization of metabolically unhealthy normal-weight individuals: risk factors and their associations with type 2 diabetes. Metabolism 64:862–871. doi: 10.1016/j.metabol.2015.03.009 CrossRefPubMedGoogle Scholar
  42. 42.
    Sattar N, McCarey DW, Capell H, McInnes IB (2003) Explaining how “high-grade” systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation 108:2957–2963. doi: 10.1161/01.CIR.0000099844.31524.05 CrossRefPubMedGoogle Scholar
  43. 43.
    Morović-Vergles J, Salamon L, Marasović-Krstulović D et al (2013) Is the prevalence of arterial hypertension in rheumatoid arthritis and osteoarthritis associated with disease? Rheumatol Int 33:1185–1192. doi: 10.1007/s00296-012-2522-1 CrossRefPubMedGoogle Scholar
  44. 44.
    Panoulas VF, Metsios GS, Pace AV et al (2008) Hypertension in rheumatoid arthritis. Rheumatology 47:1286–1298. doi: 10.1093/rheumatology/ken159 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Raili Müller
    • 1
    • 2
    Email author
  • Mart Kull
    • 1
    • 2
  • Kaja Põlluste
    • 1
  • Annika Aart
    • 1
    • 2
  • Triin Eglit
    • 1
    • 2
  • Margus Lember
    • 1
    • 2
  • Riina Kallikorm
    • 1
    • 2
  1. 1.Department of Internal MedicineUniversity of TartuTartuEstonia
  2. 2.Internal Medicine Clinic of Tartu University HospitalTartuEstonia

Personalised recommendations