The prevalence of metabolic syndrome (MetS) is significantly increased in patients with psoriatic arthritis (PsA) compared to patients with psoriasis (PsO) or rheumatoid arthritis (RA), according to a systematic review and meta-analysis published in International journal for rheumatic diseases.
MetS is defined as a collection of metabolic abnormalities, including high blood pressure, obesity, insulin resistance, and other conditions in which people also have higher levels of underlying inflammation.
PsA, PsO, and RA are all associated with systemic inflammation and increased cardiovascular morbidity and mortality. In addition, “previous studies have shown that MetS and obesity are poor prognostic indicators of minimal disease activity (MDA) in patients with PsA, despite recent advances in disease-modifying antirheumatic drug therapy,” the authors write.
To determine whether patients with PsA had increased rates of MetS compared to other populations, the researchers searched MEDLINE, PubMed, EMBASE, Google Scholar, ProQuest, Ebsco CINAHL, Scopus, ScienceDirect, Web of Science, and the Cochrane Libra for any published relevant Studies between January 1990 and August 2019.
Any study with 20 or fewer patients was excluded from the final analysis, which included 24, 89, and 53 studies for PsA, PsO, and RA, respectively.
Although there was a high degree of heterogeneity, random effects model analyzes showed:
- The pooled mean (SD) prevalence of MetS in PsA populations was 0.46 (0.06) 5% CI, 0.40-0.51)
- The prevalence of MetS in PsO and RA populations was 0.34 (0.03) (95% CI 0.32-0.37) and 0.31 (0.04) (95% CI 0, 27-0.35) 5)
- Patients with PsA had 1.62 (0.036) (95% CI 1.50-1.74) and 1.66 (0.038) (95% CI, 1.54-1.79) times more likely to have MetS compared to PsO- and RA populations
- The percentages of patients with PsA and MetS in the groups in Europe, Asia, North America and the Middle East were 47.2%, 45.78%, 34.88% and 48.4%, respectively
- In PsA populations, patients from countries with a lower gross national income (GNI) tended to have a higher prevalence of MetS
- The prevalence of PsA was also higher when compared to RA and PsO populations from matching GNI groups
The researchers found it difficult to determine how many patients with PsO also had PsA, which was a limitation of the review. In addition, some data on the prevalence of various MetS criteria were not available.
“MetS is often not examined by rheumatologists as part of routine examinations in patients with inflammatory arthritis,” the authors write. Since various metabolic risk factors can influence the effectiveness of disease-modifying therapy, this finding should be addressed through a stringent cardiovascular risk assessment and stratification in patients with PsA.
Future research should focus on using standardized definitions of MetS in PsA populations to determine whether the presence of MetS explains the increased cardiovascular risk in the patients.
Research should also investigate whether aggressive treatment for cardiovascular risk factors increases the likelihood of achieving MDA without changing pharmacologic therapy, the authors concluded.
Loganathan A, Kamalaraj N, El-Haddad C, Pile K. Systematic review and meta-analysis on the prevalence of metabolic syndrome in psoriatic arthritis, rheumatoid arthritis, and psoriasis. Int J Rheum Dis. Published online June 2, 2021. doi: 10.1111 / 1756-185X.14147