Management of Lipid Disorders

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Management of Lipid Disorders

Patients with a rheumatologic disease often have an abnormal lipid profile.

This happens as a result of the underlying disease, or because of the side

effects of medication that the patient may be taking. The abnormal lipid

profile may place the patient at a greater risk for cardiovascular disease.

For this reason, it is important that patients with rheumatic diseases

should be screened for lipid problems. Treatment usually begins with

lifestyle modifications, such as diet and exercise. In many cases it is

necessary to turn to lipid-lowering medications in order to reduce the

cardiac risk involved in lipid disorders. The selection of these medications

depend on the lipid profile, side effects of the medication, other

medications the patient may already be taking, as well as the patient's

wishes.

Systemic Lupus Erythematosus (SLE)

Lipid disorders are common in patients with SLE and most likely contribute

to the increases cardiac risks associated with SLE. Prednisone has been

linked to the increase of the lipids, while Plaquenil has been known to be

beneficial. As with all patients, the initial approach should not involve

medication. The first choice of treatment should involve diet and exercise.

Although these measures may be tried, a large majority of patients do not

respond and treatment must then include medication.

Rheumatoid Arthritis

Although cardiovascular disease has been reported to account for

approximately 1/2 of all deaths in patients with RA, there have been few

studies conducted to evaluate lipids associated with RA. In active RA,

levels of cholesterol are generally reduced when compared to inactive

disease states. As in SLE, prednisone and steroid therapy have been shown to

elevate lipids.

Given the many people that have lipid disorders, it is appropriate to obtain

fasting lipid profiles on all patients who have a rheumatic disease. The

American Heart Association recommends limiting caloric intake, saturated

fat, and cholesterol. If dietary changes coupled with regular exercise do

not achieve desired results within 3-6 months, one might consider talking

with a dietician. In some cases medication may be indicated. The choice of

drug used depends on the type of lipid disorder, the presence of other risk

factors, and the potential for side effects.

Reduction of cholesterol and treatment of lipid disorders has been proven to

reduce the risk of cardiovascular problems. This is the reason why screening

is recommended in all patients with rheumatic diseases and if a lipid

disorder is detected it should be treated aggressively.