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Metabolic Syndrome and its Outcomes in Rheumatoid Arthritis: A Review

Metabolic syndrome is a cluster of health conditions linked to increased cardiovascular disease. It is found worldwide in increasing proportions due to the modern lifestyle. The increase is visceral fat leads to secretion of harmful proinflammatory cytokines that have deleterious effects on various tissues, chiefly the heart and vasculature. Rheumatoid arthritis is a systemic inflammatory disease that shares pathogenic mechanisms with the metabolic syndrome. Patients with rheumatoid arthritis suffer increased heart disease over and above traditional risk factors. They have an increased occurrence of metabolic syndrome that enhance the risk further. Metabolic syndrome occurs early in the course of rheumatoid arthritis, creating clinical opportunities for prevention and control. Patients with both conditions also have more severe disease, pain, poorer functional status, less remission rates, and suboptimal response to treatment. Treatment of metabolic syndrome should be aggressive, using a proactive approach. Lifestyle measures are a corner stone, and this should be coupled with optimal control of rheumatoid arthritis, blood pressure, and lipid levels. The concerted efforts by a multi-disciplinary team of rheumatologists, primary care physicians, and other providers will set the stage for reducing the increased cardiovascular morbidity and mortality in these two conditions. More prospective studies are the need of the hour in determining the roles of the risk factors and the effects of lifestyle changes and medications in reducing the impact of the metabolic syndrome and its contribution to the already burdened pathology of rheumatoid arthritis. This narrative review discusses the latest in the field and identifies the areas that need further research.