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银屑病性关节炎患者常发生代谢综合征和胰岛素抵抗

Metabolic syndrome, insulin resistance occur frequently in psoriatic arthritis patients
来源:爱思唯尔 2014-07-09 13:46点击次数:470发表评论

一项单中心横断面队列研究显示,代谢综合征和胰岛素抵抗不仅在银屑病性关节炎患者中较常见,而且均与炎症性肌肉骨骼疾病严重程度相关(J. Rheumatol. 2014;41:1357-65)。


这项研究纳入了1年内在一家风湿门诊就诊的连续283例长期银屑病性关节炎患者,其中44%合并代谢综合征,16%合并胰岛素抵抗。爱尔兰圣文森特大学医院风湿科的Muhammad Haroon医生指出:“上述研究结果支持我们之前的猜测,即代谢综合征与胰岛素抵抗风险与银屑病性关节炎严重程度呈正相关,这很可能反映了炎症负担的增加。”


银屑病性关节炎已被证实与心血管风险增加相关,而心血管疾病是银屑病性关节炎患者的首要死亡原因之一。然而迄今为止,尚未在银屑病性关节炎患者中充分研究这两种主要的心血管危险因素。“因此我们提出假设,银屑病性关节炎患者的代谢综合征和胰岛素抵抗疾病负担较高,进而因炎症负担增加而更易罹患心血管疾病。”


本项研究的受试者均具有至少10年的银屑病性关节炎病史(平均19年),女性略超过50%,平均年龄为54.6岁。研究者发现,共有124例(44%)患者合并代谢综合征。“更加令人警惕的是,研究结果显示大约50%的新诊断代谢综合征患者同时存在4~5项风险特征。”具体而言,在这些银屑病性关节炎患者中,常见的代谢综合征成分为:高血压(74%)、大腰围(56%)、高甘油三酯(44%)。


多变量分析显示,代谢综合征与更严重的疾病、更大的吸烟量(包-年)和更差的EQ-5D评分显著相关。即使校正胰岛素抵抗后,代谢综合征仍与更严重的疾病显著相关。


在可查到胰岛素抵抗数据的263例患者中,有41例(16%)存在胰岛素抵抗。多变量分析显示,即使校正代谢综合征后,胰岛素抵抗仍与更严重的疾病、更大的银屑病发病年龄以及更高的体重指数显著相关。


代谢综合征和胰岛素抵抗均在病情较严重的银屑病性关节炎患者中更常见。判断银屑病性关节炎病情的依据是,目前和既往皮肤评估、炎症标志物、疾病活动度指标、畸形关节数量,以及指炎、起止点炎、外周关节侵蚀、骨质溶解和骶髂关节炎等存在与否。


上述研究结果提示,“炎症性关节炎疾病负担高或者合并严重银屑病性关节炎,可能在代谢综合征和/或胰岛素抵抗的发生过程中扮演着重要角色”。研究者表示,这些发现“还可能有助于使银屑病性关节炎患者了解风险分层”。


研究者无利益冲突披露。


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By: MARY ANN MOON, Internal Medicine News Digital Network


The metabolic syndrome and insulin resistance are not just common among patients with psoriatic arthritis, but both also correlate with the severity of the inflammatory musculoskeletal disease, according to a single-center, cross-sectional cohort study.


In the study of 283 consecutive white patients with longstanding psoriatic arthritis who attended a rheumatology clinic during a 1-year period, 44% were found to have the metabolic syndrome and 16% to have insulin resistance. "Our findings are novel and support our pretest hypothesis that the risk of metabolic syndrome and insulin resistance increases with the severity of underlying psoriatic arthritis, probably reflecting the increasing burden of inflammation," said Dr. Muhammad Haroon of the department of rheumatology and his associates at St. Vincent’s University Hospital, Dublin.


Psoriatic arthritis is known to be associated with heightened cardiovascular risk, and CV diseases are the leading causes of death in patients with psoriatic arthritis. Until now, however, the prevalences of these two major CV risk factors have not been well studied in patients with psoriatic arthritis. "We hypothesized, therefore, that there might be a greater burden of metabolic syndrome and insulin resistance in psoriatic arthritis, and consequently of cardiovascular diseases because of a greater inflammatory load," Dr. Haroon and his colleagues wrote (J. Rheumatol. 2014;41:1357-65).


The patients had psoriatic arthritis for a duration of at least 10 years (mean of 19 years), and just over half of the patients were women. Their mean age was 54.6 years.


A total of 124 patients (44%) were found to have the metabolic syndrome. "Even more alarming was the finding that about 50% of these newly diagnosed patients with metabolic syndrome had a combination of 4 or 5 of these risk features," the investigators said. In particular, elevated blood pressure (74%), greater waist circumference (56%), and elevated triglycerides (44%) were common among these psoriatic arthritis patients.


On multivariate analysis, metabolic syndrome was significantly associated with more severe disease, higher smoking pack-years, and worse EuroQol-5 dimension (EQ-5D). Metabolic syndrome was significantly associated with severe disease, even after adjustment for the presence of insulin resistance.


A total of 41 patients (16%) had insulin resistance of the 263 for whom insulin resistance data were available, which on multivariate analysis was significantly associated more severe disease, older age at the onset of psoriasis, and higher body-mass index, even after adjusting for the presence of metabolic syndrome.


Both the metabolic syndrome and insulin resistance were more frequent among patients with the most severe psoriatic arthritis, as measured by current and previous skin assessments; inflammatory markers; measures of disease activity; the number of deformed joints; and the presence of dactylitis, enthesitis, peripheral joint erosions, osteolysis, and sacroiliitis, the investigators said.


The study findings suggest, but do not establish, that "the higher burden of inflammatory arthritis or the combination of severe psoriatic disease features play major roles in the development of the metabolic syndrome and/or insulin resistance," Dr. Haroon and his associates said.


Their observations "can also help inform risk stratification" of patients with psoriatic arthritis, they added.


No disclosures were provided.


学科代码:内科学 内分泌学与糖尿病 风湿病学 皮肤病学   关键词:银屑病性关节炎;代谢综合征;胰岛素抵抗
来源: 爱思唯尔
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