Hyperlipidemia in rheumatoid arthritis patients in Saudi Arabia: Correlation with C-reactive protein levels and disease activity

Objectives:

To determine the prevalence of hyperlipidemia in patients from Saudi Arabia with rheumatoid arthritis (RA), and to investigate its relationship with C-reactive protein level and disease activity.

Methods:

A cross-sectional 3-year study was conducted on RA patients at King Abdulaziz University Hospital, Saudi Arabia between January 2011 and December 2013. Lipid profiles were determined following 12-hour overnight fasting, and the association of lipid profiles with C-reactive protein (CRP) levels and disease activity was determined.

Results:

This study involved a total of 180 RA patients (mean age: 40.49±12.19 years). These subjects displayed a high prevalence of elevated total cholesterol (55.1%), and low-density lipoprotein cholesterol (51.2%). Notably, we detected a significant association between increased total cholesterol and high CRP levels (p=0.002). Moreover, we observed a positive correlation between total cholesterol and disease activity, as measured using the 28-Joint Disease Activity Score index (r=0.23, p=0.036).

Conclusions:

Hyperlipidemia is common among RA patients and is significantly associated with CRP levels and disease activity. Our findings emphasize the need to raise awareness among healthcare professionals regarding the development of hyperlipidemia when RA is active.Rheumatoid arthritis (RA) is a chronic inflammatory disorder that typically affects middle-aged individuals. The estimated prevalence of RA in Saudi Arabia is 2.2 per thousand people; it is more common in women, and incidence increases with age.1 If left untreated, RA is associated with high morbidity and mortality, which specifically results from cardiovascular disease (CVD).2,3 In order to reduce the CVD-related mortality rate in RA patients, the European League Against Rheumatism (EULAR) has recommended annual risk assessment, management of identified risk factors, and aggressive suppression of inflammation.4-6 In this regard, it has been demonstrated that treating RA with disease-modifying anti-rheumatic drugs (DMARDs) can effectively reduce CVD-related mortality.4,7 Cardiovascular disease is not only linked to traditional risk factors as hyperlipidemia, but also to nontraditional risk factors including chronic systemic inflammation. Notably, changes in lipid profiles have been established as traditional cardiovascular (CV) risk factors, but also as non-traditional that is directly linked to active inflammation (namely, disease activity).8-11 In fact, studies on CVD in RA patients have indicated that chronic systemic inflammation can enhance the development of atherosclerosis and hyperlipidemia.12,13 In this regard, the prevalence of hyperlipidemia in RA patients is known to vary between 20-45%.14,15 Hyperlipidemia in RA patients in Saudi Arabia has not been thoroughly investigated to date. Therefore, the objective of the present study was to estimate the prevalence of hyperlipidemia in RA patients in Saudi Arabia, and to identify possible associated risk factors, including inflammatory markers.