Serum Lipid Alterations in Early Rheumatoid Arthritis Patients on Disease Modifying Anti Rheumatoid Therapy

Abstract

Dyslipidaemia is a major CVD risk factor in the general population. Current evidence suggests that lipid metabolism is altered in RA due to inflammation, and that use of anti-inflammatory therapy may reverse some of these changes. The objective of our study is to compare the effect of treatment with DMARD on lipid fractions after 6 months of therapy. Forty patients who met the American College of Rheumatology, ACR/EULAR criteria for rheumatoid arthritis, with disease duration of less than 1 year and no prior treatment were included in the study. Thirty healthy volunteers were included as controls. The mean DAS-28 at disease onset was 5.15 ± 1.3. Early Rheumatoid Arthritis (ERA) patients exhibited higher serum levels of total cholesterol (TC) and lowdensity lipoprotein cholesterol (LDL-C) and lower serum highdensity lipoprotein cholesterol (HDL-C) levels compared to controls. As a consequence, the atherogenic index of plasma [log (TG/HDL-C)], the atherogenic indices: TC/ HDL-C as well as LDLC/HDL-C was significantly higher in ERA patients compared to controls. After 6 months of treatment, there was significant reduction of the DAS 28, HDL-C and Apo A-I improved and Lp(a) decreased significantly. All lipid ratios improved, a phenomenon primarily due to the increase in serum HDL-C levels. These changes were inversely correlated with CRP and ESR. In conclusion, ERA patients are characterized by an atherogenic lipid profile, which improves with DMARD therapy.

<p>Assessment of Serum Lipid Profiles and High-sensitivity C-reactive Protein Among Patients Suffering from Rheumatoid Arthritis at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study</p>

“…3 The significant elevation of these atherogenic indices among cases agreed with one previous research work. 12…”

“…Untreated RA leads to elevated levels of the TC, LDC-C and decreased concentration of the HDL-C. 11 However, early diagnosed RA patients taking disease-modifying antirheumatic drugs, including hydroxychloroquine, methotrexate, and nonsteroidal anti-inflammatory drugs show elevation of HDL-C and lower disease activity. 12 The American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) state the common criteria to measure disease activity, including acute phase response, physical disability and swollen joint counts. 13 The intention of disease activity score (DAS) is to manage inflammatory status of RA patients.…”

“…Untreated RA leads to elevated levels of the TC, LDC-C and decreased concentration of the HDL-C. 11 However, early diagnosed RA patients taking disease-modifying antirheumatic drugs, including hydroxychloroquine, methotrexate, and nonsteroidal anti-inflammatory drugs show elevation of HDL-C and lower disease activity. 12 …”

Usefullnes of atherogenic indices and Ca-LDL level to predict subclinical atherosclerosis in patients with psoriatic arthritis?

“…Similarly, Sunitha et al reported that AIP was significantly increased in patients with CIMT Carotid intima-media thickness psoriasis than healthy controls and positively correlated with psoriasis area severity index [40]. Also, it has recently been reported that the AIP may be a good biomarker for the early detection of subclinical atherosclerosis in patient with various rheumatologic diseases, such as ankylosing spondylitis, rheumatoid arthritis, Behçet's disease, systemic lupus erythematosus, and familial Mediterranean fever [41][42][43][44][45]. AC is ratio relying on the significance of HDL-C in predicting the risk of cardiovascular disease [25].…”

Values and Correlations between C-Reactive Protein and Apolipoprotein B after Treatment with Methotrexate at Patients with Rheumatoid Arthritis

“…In a similar study, Magarò M et al have also shown Apo A1 and Apo B to be significantly lower in RA patients. They have also shown reduced levels of albumin in these patients which perhaps indicate a reduced rate of synthesis of proteins by the liver reflected in the decreased levels of the apoproteins [30]. A study by Eva Hurt Camejo et al, showed an Apo B decrease by 7 %, while other lipoproteins were in the normal range in the RA patients and similar to those in the controls [31].…”