A PRESENÇA DE DISLIPIDEMIA É MAIOR EM PACIENTES COM ARTRITE REUMATOIDE QUE TEM ESTEATOSE HEPÁTICA NÃO ALCÓOLICA
DOI:
https://doi.org/10.63845/589kvm75Palavras-chave:
artrite reumatoide, esteatose, dislipidemiaResumo
Introdução: Na população sem artrite reumatoide a esteatose hepática está associada a síndrome metabólico, perfil lipídico anormal e aumento de biomarcadores pró-inflamatórios como PCR. Em diabéticos a sua presença se associa ao aumento do risco de eventos cardiovasculares. Estudos que avaliam o impacto da presença de esteatose em pacientes com AR são escassos. Objetivo: Verificar a associação da esteatose hepática com parâmetros clínicos de atividade da AR e a presença de comorbidades. Métodos: Estudo caso-controle que incluiu 55 pacientes com AR e esteatose hepática não alcóolica versus 55 pacientes com AR sem esteatose, pareadas pelo sexo e idade. Utilizou-se ultrassonografia como método diagnóstico de esteatose hepática para estratificação dos grupos. Resultados: Dislipidemia foi presente em 80% no grupo caso (esteatose) e 63,6% no grupo controle com OR=2,3 (p=0,05). Da mesma forma, 74,5% dos pacientes com esteatose faziam uso de estatina versus 54,5% no grupo controle com OR=2,44 (p=0,046). A pesquisa de associação da presença de esteatose com outras comorbidades como HAS, DM tipo 2, hipotireoidismo e com o hábito do tabagismo não mostraram significância estatística (p>0,05). Em relação aos parâmetros laboratoriais analisados, como o FR, a VHS e a PCR, estes não diferiram nos dois grupos comparados (p>0,05). Conclusão: Dislipidemia é mais frequente em pacientes com AR que apresentam esteatose hepática, o que justifica a maior utilização de estatina neste subgrupo. Outras comorbidades e parâmetros laboratoriais da AR não se associam a presença de esteatose. Considerando ser a presença de esteatose hepática um fator de risco para evento cardiovascular na população em geral, em particular nos diabéticos, o reconhecimento da sua prevalência em AR e da sua associação com dislipidemia nestes pacientes é importante, devido a possibilidade de medidas de prevenção primária de eventos cardiovascular.
Referências
Tobon GJ, Youinou P, Saraux A. The environment, geo-epidemiology, and autoimmun disease: Rheumatoid arthritis. J Autoimmun 2010;35:(1):10 -14. DOI: https://doi.org/10.1016/j.jaut.2009.12.009
Hemminki K, Li X, Sundquist J, Sundquist K. Familial Associations of Rheumatoid Arthritis With Autoimmune Diseases and Related Conditions. Arthritis Rheum. 2009;60(3):661–8. DOI: https://doi.org/10.1002/art.24328
Mota LMH, Cruz BA, Brenol CV, Pereira IA, Rezende-Fronza LS, Bertolo MB, et al. Consenso 2012 da Sociedade Brasileira de Reumatologia para o tratamento da artrite reumatoide. Rev Bras Reumatol. 2012;52(2):135-74. DOI: https://doi.org/10.1590/S0482-50042012000200002
Corbacho MI, Dapueto JJ. Avaliação da capacidade funcional e da qualidade de vida de pacientes com artrite reumatóide. Rev Bras Reumatol. 2010;50(1):31-43. DOI: https://doi.org/10.1590/S0482-50042010000100004
Mota LMH, Laurindo IMM, Neto LLS. Avaliação prospectiva da qualidade de vida em uma coorte de pacientes com artrite reumatoide inicial. Rev Bras Reumatol. 2010;50(3):249-61. DOI: https://doi.org/10.1590/S0482-50042010000300005
Södergren A, Stegmayr B, Lundberg V, Öhman ML, Wallberg-Jonsson S. Increased incidence of and impaired prognosis after acute myocardial infarction among patients with seropositive rheumatoid arthritis. Ann Rheum Dis. 2007;66:263–6. DOI: https://doi.org/10.1136/ard.2006.052456
Turesson C, Jacobsson LTH, Matteson EL. Cardiovascular co-morbidity in rheumatic diseases. Vasc Health Risk Manag. 2008;4(3):605-14. DOI: https://doi.org/10.2147/VHRM.S2453
Peters MJL, Symmons DPM, McCarey D, Dijkmans BAC, Nicola P, Kvien TK, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010;69:325–31. DOI: https://doi.org/10.1136/ard.2009.113696
Innala L, Möller B, Ljung L, Magnusson S, Smedby T, Södergren A, et al. Cardiovascular events in early RA are a result of inflammatory burden and traditional risk factors: a five year prospective study. Arthritis Res Ther. 2011;13:1-10. DOI: https://doi.org/10.1186/ar3442
Turesson C, McClelland RL, Christianson TJH, Matteson EL. Severe extra-articular disease manifestations are associated with an increased risk of first ever cardiovascular events in patients with rheumatoid arthritis. Ann Rheum Dis. 2007;66:70–5. DOI: https://doi.org/10.1136/ard.2006.052506
Lindhardsen J, Ahlehoff O, Gislason GH, Madsen OR, Olesen JB, Svendsen JH, et al. Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study. BMJ. 2012;344:1-12. DOI: https://doi.org/10.1136/bmj.e1257
Michaud K, Wolfe F. Comorbidities in Rheumatoid Arthritis. Best Pract Res Clin Rheumatol. 2007;21(5):885-906. DOI: https://doi.org/10.1016/j.berh.2007.06.002
Nurmohamed MT. Atherogenic lipid profiles and its management in patients with rheumatoid arthritis. Vasc Health Risk Manag. 2007;3(6):845–52.
Karvounaris SA, Sidiropoulos PI, Papadakis JA, Spanakis EK, Bertsias GK, Kritikos HD, et al. Metabolic syndrome is common among middle-to-older aged Mediterranean patients with rheumatoid arthritis and correlates with disease activity: a retrospective, cross-sectional, controlled, study. Ann Rheum Dis. 2007;66:28–33. DOI: https://doi.org/10.1136/ard.2006.053488
Ede AEV, Laan RF, Blom HJ, De Abreu RA, Putte LBV. Methotrexate in Rheumatoid Arthritis: an update with focus on mechanisms involved in toxicity. Semin Arthritis Rheum. 2008;27(5):277-92. DOI: https://doi.org/10.1016/S0049-0172(98)80049-8
Pereira IA, Borba EF. The role of inflammation, humoral and cell mediated autoimmunity in the pathogenesis of atherosclerosis. Swiss Med Wkly. 2008 Sep 20;138(37-38):534-9.
Chodick G, Amital H, Shalem Y, Kokia E, Heymann AD, Porath A, et al. Persistence with Statins and Onset of Rheumatoid Arthritis: A Population-Based Cohort Study. PLoS Med. 2010;7(9):1-13. DOI: https://doi.org/10.1371/journal.pmed.1000336
Klaasen R, Herenius MMJ, Wijbrandts CA, Jager W, Tuyl LH, Nurmohamed MT et al. Treatment-specific changes in circulating adipocytokines: a comparison between tumour necrosis factor blockade and glucocorticoid treatment for rheumatoid arthritis. Ann Rheum Dis. 2012;10:1-9. DOI: https://doi.org/10.1136/annrheumdis-2011-200646
Myasoedova E, Crowson CS, Kremers HM, Roger VL, Fitz-Gibbon PD, Therneau TM, et al. Lipid paradox in rheumatoid arthritis: the impact of Serum lipid measures and systemic inflammation on The risk of cardiovascular disease. Ann Rheum Dis. 2011;70(3):482–7. DOI: https://doi.org/10.1136/ard.2010.135871
Morris SJ, Wasko MCM, Antohe JI, Sartorius JA, Kirchner HL, Dancea S, et al. Hydroxychloroquine Use Associated With Improvement in Lipid Profiles in Rheumatoid Arthritis Patient. Arthritis Care Res. 2011;63(4):530–4. DOI: https://doi.org/10.1002/acr.20393
Pereira IA, Mota LM, Cruz BA, Brenol CV, Fronza LS, Bertolo MB, et al. 2012 Brazilian Society of Rheumatology Consensus on the management of comorbidities in patients with rheumatoid arthritis. Rev Bras Reumatol. 2012;52(4):483-95. DOI: https://doi.org/10.1590/S0482-50042012000400002
Pereira IA. Rheumatoid arthritis: why to treat only arthritis, knowing that comorbidities are common and determine morbidity and mortality? Rev Bras Reumatol. 2012;52(4):472-3. DOI: https://doi.org/10.1590/S0482-50042012000400001
Abraham S, Begum S, Isenberg D. Hepatic manifestations of autoimunne rheumatic diseases. Ann Rheum Dis. 2004;(63):123-9. DOI: https://doi.org/10.1136/ard.2002.001826
Lazo M, Hernaez R, Bonekamp S, Kamel IR, Brancati FL, Guallar E, et al. Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ 2011;343:1-9. DOI: https://doi.org/10.1136/bmj.d6891
Klementina FT, Damjana R, Nonalcoholic Fatty Liver Disease: Focus on Lipoprotein and Lipid Deregulation. J Lipids. 2011;2011:1-14. DOI: https://doi.org/10.1155/2011/783976
Boyer JF, Gourraudc PA, Cantagrela A, Davignonb JL, Constantina A, Traditional cardiovascular risk factors in rheumatoid arthritis: A meta-analysis. Joint Bone Spine. 2011;78(2):179-83. DOI: https://doi.org/10.1016/j.jbspin.2010.07.016
Carvalho MSA, Cabral PC, Arruda IKG, Burgos MGPA, Diniz AS, Pernambuco JRB, Risk factors associated with hepatic steatosis; a study in patients in the Northeast Brazil. Nutr Hosp. 2012;27(4):1344-50.
Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC et al. Prevalence of Hepatic Steatosis in an Urban Population in the United States: Impact of Ethnicity. Hepatology 2004;40:1387-95. DOI: https://doi.org/10.1002/hep.20466
Di Minno MND, Peluso R, Iervolino S, Lupoli R, Russolillo A, et al. Hepatic steatosis, carotid plaques and achieving MDA in psoriatic arthritis patients starting TNF-a blockers treatment: a prospective study. Arthritis Res Ther. 2012 Oct;14(5):1-8. DOI: https://doi.org/10.1186/ar4049
Giles JT, Bathon JM. Hepatic Steatosis in Rheumatoid Arthritis: Associations with Disease Characteristics, Pharmacotherapies, and Atherosclerosis. Arthritis Rheum. 2012 Nov;64:9-14.
Sheng X, Murphy MJ, Macdonald TM, Wei L. Effectiveness of Statins on Total Cholesterol and Cardiovascular Disease and All-cause Mortality in Osteoarthritis and Rheumatoid Arthritis. J Rheumatol 2012;39:32-40. DOI: https://doi.org/10.3899/jrheum.110318
Ridker PM, Cannon CP, Morrow D, Rifai N, Rose LM, McCabe CH, et al. C-reactive protein levels and outcomes after statin therapy. N Engl J Med. 2005 Jan 6;352(1):20-8. DOI: https://doi.org/10.1056/NEJMoa042378
McCarey DW, McInnes IB, Madhok R, Hampson R, Scherbakov O, Ford I, et al. Trial of Atorvastatin in Rheumatoid Arthritis (TARA): double-blind, randomised placebo-controlled trial. Lancet. 2004 Jun 19;363(9426):2015-21. DOI: https://doi.org/10.1016/S0140-6736(04)16449-0
Makadia SS, Blaha M, Keenan T, Ndumele C, Jones S, Defilippis A, et al. Relation of Hepatic Steatosis to Atherogenic Dyslipidemia. Am J Cardiol. 2013;13:21-4. DOI: https://doi.org/10.1016/j.amjcard.2013.08.001
Steiner G, Urowitz MB. Lipid profiles in patients with rheumatoid arthritis: mechanisms and the impact of treatment. Semin Arthritis Rheum. 2009 Apr;38(5):372-81. DOI: https://doi.org/10.1016/j.semarthrit.2008.01.015
Toms TE, Panoulas VF, Kitas GD. Dyslipidaemia in Rheumatological Autoimmune Diseases. Open Cardiovasc Med J. 2011;5:64-75. DOI: https://doi.org/10.2174/1874192401105010064
Pieringer H, Brummaier T, Schmid M, Pichler M, Hayat-Khayyati A, Ebner S, et al.Rheumatoid arthritis is an independent risk factor for an increased augmentation index regardless of the coexistence of traditional cardiovascular risk factors. Semin Arthritis Rheum. 2012 Aug;42(1):17-22. DOI: https://doi.org/10.1016/j.semarthrit.2012.02.003
Roman MJ, Devereux RB, Schwartz JE, Lockshin MD,Paget SA,Davis A, et al. Arterial stiffness in chronic inflammatory diseases. Hypertension. 2005 Jul;46(1):194-9. DOI: https://doi.org/10.1161/01.HYP.0000168055.89955.db
Solomon DH, Karlson EW, Rimm EB, Cannuscio CC, Mandl LA, Manson JE, et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation. 2003 Mar 11;107(9):1303-7. DOI: https://doi.org/10.1161/01.CIR.0000054612.26458.B2
Gabriel SE, Crowson CS. Risk factors for cardiovascular disease in rheumatoid arthritis. Curr Opin Rheumatol. 2012 Mar;24(2):171-6. DOI: https://doi.org/10.1097/BOR.0b013e32834ff2fd
Nurmohamed MT. Cardiovascular risk in rheumatoid arthritis. Autoimmunity Reviews. 8 (2009) 663–667. DOI: https://doi.org/10.1016/j.autrev.2009.02.015
Panoulas VF,Metsios GS,Pace AV, John H, Treharne GJ,Banks MJ, et al. Hypertension in rheumatoid arthritis. Rheumatology (Oxford). 2008 Sep;47(9):1286-98. DOI: https://doi.org/10.1093/rheumatology/ken159
Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002 Apr;346(16):1221-31. DOI: https://doi.org/10.1056/NEJMra011775
Lindhardsen J, Ahlehoff O, Gislason GH, Madsen OR, Olesen JB, Torp-Pedersen C, et al. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis. 2011 Jun;70(6):929-34. DOI: https://doi.org/10.1136/ard.2010.143396
Klieverik LP, Coomans CP, Endert E, Sauerwein HP, Havekes LM, Voshol PJ, et al. Thyroid hormone effects on whole-body energy homeostasis and tissue-specific fatty acid uptake in vivo. Endocrinology 2009;150:5639–48. DOI: https://doi.org/10.1210/en.2009-0297
Nedvidkova J, Haluzik M, Bartak V, Dostalova I, Vlcek P, Racek P, et al. Changes of noradrenergic activity and lipolysis in the subcutaneous abdominal adipose tissue of hypo- and hyperthyroid patients: an in vivo microdialysis study. Ann N Y Acad Sci. 2004;1018:541–9. DOI: https://doi.org/10.1196/annals.1296.067
Sinha RA, You SH, Zhou J, Siddique MM, Bay BH, Zhu X, et al. Thyroid hormone stimulates hepatic lipid catabolism via activation of autophagy. J Clin Invest. 2012;122:2428–38. DOI: https://doi.org/10.1172/JCI60580
Ittermann T, Haring R, Wallaschofski H, Baumeister SE, Nauck M, Dorr M, et al. Inverse association between serum free thyroxine levels and hepatic steatosis: results from the Study of Health in Pomerania. Thyroid. 2012;22:568–74. DOI: https://doi.org/10.1089/thy.2011.0279
Chung GE, Kim D, Kim W, Yim JY, Park MJ, Kim YJ, et al. Non-alcoholic fatty liver disease across the spectrum of hypothyroidism. J Hepatol. 2012;57:150–6. DOI: https://doi.org/10.1016/j.jhep.2012.02.027
Kutluturk F, Yuce S, Tasliyurt T, Yelken BM, Aytan P, Ozturk B, et al. Changes in metabolic and cardiovascular risk factors before and after treatment in overt hypothyroidism. Med Glas. 2013;10(2):348-53.
Barbuio R, Milanski M, Bertolo MB, Saad MJ, Velloso LA. Infliximab reverses steatosis and improves insulin signal transductionin liver of rats fed a high-fat diet. J Endocrinol 2007;194:539–50. DOI: https://doi.org/10.1677/JOE-07-0234
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Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
