Prevalence of metabolic syndrome in psoriatic arthritis: systematic literature review and results from the CARMA cohort

Abstract

Background: The cardiovascular burden in psroriatic arthritis (PsA) is well recognized. Objectives: To analyze the prevalence of metabolic syndrome (MetS) in patients with PsA. Methods: We conducted a systematic literature review (SLR) and a sub-analysis of the CARMA cohort. In the SLR, we searched in Pubmed, Embase, the Cochrane Central Library, and the ClinicalTrial until March 2019 using Mesh terms and free text words. We included SLR, clinical trials and observational studies analyzing the prevalence or frequency of MetS in PsA. Two reviewers selected articles, assessed the quality of the studies and collected data independently. The CARMA cohort was designed to establish the cardiovascular (CV) morbidity and associated risk factors for CV disease. It includes data from patients with chronic inflammatory rheumatic diseases (including PsA) of 67 Spanish hospitals. A sub-analysis of the prevalence of metS in PsA was performed using the National Cholesterol Education Program Adult Treatment Panel III criteria updated in 2005, which requires the presence of ≥3 of the following: high waist circumference, low HDL cholesterol level, high triglyceride level, high blood pressure and high fasting glucose values. Results: A total of 18 articles of moderate to high quality, were selected in the SLR. The included patients presented a balanced distribution by sex, with an average age ranging from 42 to 59 years. The frequency of MetS varied from 23.5% to 62.9% depending on the definition of MetS. The most widely used classification method was the National Cholesterol Education Program, followed by the method recommended by the International Diabetes Federation in 2009. A total of 724 patients with PsA were included in the CARMA study, of whom 327 (45.4%) were women and 157 (21.8%) smokers. The mean age at baseline was 51 ± 12 years and the mean duration of PsA disease 9 (4-16) years. Hypertension was the most frequently altered parameter (66.8%), followed by fasting glucose (42.6%) and hypertriglyceridemia (30.6%). Table 1 shows the frequency of patients according to the number of MetS components. A total of 222 (30.6%) PsA patients presented metabolic syndrome.