1. LIPID PROFILE OF EARLY RHEUMATOID ARTHRITIS PATIENTS
NS Shahril1, N Rosli1, N Abdullah2, H Hussein1, S Murad2
1 Department of Medicine, Putrajaya Hospital, Malaysia
2 Institute of Medical Research, Kuala Lumpur, Malaysia
INTRODUCTION
Dyslipidaemia is a strong predictor of cardiovascular (CV) disease, with low-density lipoprotein cholesterol (LDL-C) being the primary target in treatment guidelines. Lipid profile of patients with active or untreated RA is characterized by a decrease in serum levels of high-density lipoprotein cholesterol (HDL-C). There is evidence to suggest that total-cholesterol (TC) and LDL-C levels decrease after diagnosis of RA which is not related to lipid-lowering therapy.
OBJECTIVE: To determine the patterns of lipid profile of RA patients at RA diagnosis and in the later course of their disease.
METHOD
This is a retrospective study of the subgroup of MyEIRA (Malaysian Epidemiology in Rheumatoid Arthritis) patients from Putrajaya Hospital in whom RA diagnosis was made in year A total of 96 patients in the MyEIRA subgroup were included.
Demographic data, medication (disease-modifying anti-rheumatic drugs [DMARDs] and statin) and baseline lipid profile done within first two years of RA diagnosis were extracted from electronic medical records. The lipid profiles from the period of 2011 – 2012 were reviewed. The difference in the mean of lipid profile components and medication effects on the mean difference between early RA and later course of disease was analyzed.
RESULTS
At diagnosis 18.8% of patients had low HDL-C (defined as < 1.03 mmol/l) compared to 20.8% of patients subsequently and 13.6% initially had elevated LDL-C (defined as LDL-C > 4.12 mmol/l) which reduced to 9.4% subsequently.
In early RA, the mean TC was 5.39 mmol/l, mean LDL-C was 3.39 mmol/l, mean HDL-C-was 1.42 mmol/l, and mean triglyceride (Tg) was 1.27 mmol/l. In later course of the disease, the mean TC was 5.14 mmol/l, mean LDL-C was 3.23 mmol/l, mean HDL-C was 1.41 mmol/l and mean Tg was 1.14 mmol/l. Although there is a reduction in the mean TC, LDL-C and Tg between early RA and in later disease course, it was only significant for the changes in mean TC (p= 0.22) and Tg levels (p = 0.18).
Overall, DMARDs had no effect on the lipid profile. Statin therapy has a significant effect on the mean difference in TC (p=0.14), LDL-C (p=0.20) and Tg (p=0.49). 40.7% of patients were on statin therapy.
CONCLUSION
A small percentage of RA patients exhibit the classic dyslipidaemia pattern of low HDL-C and elevated LDL-C. Statin therapy has an effect on the lipid profile and its use in this population is quite substantial.
REFERENCES
1. Dyslipidaemia in Rheumatological Autoimmune Diseases. Tracey E Toms, Vasileios F Panoulas, George D Kitas. The Open Cardiovascular Medicine Journal, 2011, 5,