RESEARCH - MTX therapy is associated with reduced prevalence of metabolic syndrome in RA patients over age 60

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Arthritis Research & Therapy 2009, 11:R110doi:10.1186/ar2765

Published: 16 July 2009

Methotrexate therapy associates with reduced prevalence of the

metabolic syndrome in rheumatoid arthritis patients over the age of

60- more than just an anti-inflammatory effect? A cross sectional

study

Tracey E Toms1,2 , Vasileios F Panoulas1 , Holly 1 , MJ

1 and D Kitas1,2

1Department of Rheumatology, Dudley Group of Hospitals NHS Trust,

s Hall Hospital, Dudley, West Midlands, DY1 2HQ, UK

2ARC Epidemiology Unit, Manchester University, Oxford Road,

Manchester, M13 9PT, UK

Abstract

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 Group for Study of 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

0.33–0.81, 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.

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Read the full article here:

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

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