Metabolic Syndrome, Obesity, Diabetes and the worsening of Rheumatoid Arthritis
The United States is becoming unhealthier: The rates of obesity, diabetes and metabolic syndrome are on a continued upward trendl. Unfortunately, these illnesses of an inactive and overeating society are having a negative impact on those who suffer from rheumatoid arthritis.
Metabolic syndrome is a combination of conditions that can increase the risk of heart disease and diabetes, among other problems. Metabolic syndrome is characterized by excessive fat around the abdomen (or abdominal obesity) in the presence of 3 of the following 5 findings:
- a waist size 40 inches or more in men or 35 inches or more in women
- elevated triglycerides
- reduced HDL ("good") cholesterol
- elevated blood pressure
- elevated blood sugar
A study of rheumatoid arthritis patients found that metabolic syndrome was associated with disease activity. In fact, the risk of having moderate to high rheumatoid arthritis disease activity was 9 times higher in those patients who also suffered from metabolic syndrome compared to those rheumatoid arthritis patients who were not burdened by it.
Obesity can cause, and be caused by, Rheumatoid Arthritis
Obesity is a risk factor for rheumatoid arthritis and cardiovascular disease, and therefore is associated with an increased risk of death. Matters are made more complicated because obesity can result from some of the treatments we doctors give to rheumatoid arthritis patients: Obesity can result from prednisone use, and from the use of tumor necrosis factor (TNF) inhibiting drugs (such as Remicade, Humira and Enbrel). And, of course, obesity can result from the relative inactivity due to joint damage.
Equally disturbing, obese patients are less likely to respond to disease modifying drugs such as methotrexate and Arava. In many ways, obesity adversely affects the quality of life of rheumatoid arthritis patients.
Interestingly, the diagnosis of obesity is not made as often as it should. Studies have shown that even when the diagnosis of obesity is made, less than 50% of the patients so diagnosed were actually advised by their physician to lose weight. Along similar lines, less than 50% of overweight or obese patients with arthritis were ever told by their physician that weight loss could help ease some of the pain of arthritis. Rheumatologists need to confront obesity more assertively.
Link Between Diabetes and Rheumatoid Arthritis is Less Clear
A clear relationship between diabetes and rheumatoid arthritis has not been established. There are some proposals that the inflammation due to rheumatoid arthritis may result in insulin resistance, and thus increase the risk of developing Type 2 diabetes. But the statistics do not show a strong association between these two illnesses. However, diabetes increases the risk of infection, as do many of the immunosuppressive drugs used to treat rheumatoid arthritis.
In conclusion, other health problems such as obesity and the metabolic syndrome have a significant impact on rheumatoid arthritis patients. This impact is demonstrated as increased infection rates, poorer quality of life and a shorter life span.
Obviously, the rheumatologist should promote preventive care and the aggressive treatment of these problems, common in the general population, which can have a negative impact on rheumatoid arthritis disease activity.