Monitoring, Management, and Lipid Profiles in Systemic Inflammation in RA

When patients with rheumatoid arthritis (RA) with an elevated erythrocyte sedimentation rate (ESR) were compared with patients with RA and a normal ESR, lipid profiles were no more likely to be evaluated and patients were no more likely to be prescribed lipid-lowering medication, according to research presented at the National Lipid Association (NLA) Scientific Sessions 2022 from June 2^nd through 5^th, in Scottsdale, AZ. These findings add to the paradox in RA patients of LDL inversely correlated with inflammation.

The leading cause of early death among patients with RA is cardiovascular disease (CVD), and while decreased inflammation and better CVD outcomes are associated with lipid-lowering therapies in these patients, increased inflammation has been associated with low HDL, LDL, and total cholesterol levels making treatment options problematic. In RA patients, researchers sought to investigate the association between lipid markers and inflammation by ESR and to document lipid management and monitoring practices in these patients.

To accomplish this, they conducted a retrospective cross-sectional study of 756 patients (mean 54.1 years of age; 80.7% female; 43.4% non-Hispanic Black) with RA and an electronic medical record (EMR) of ESR (elevated defined as ≥20mm/hr), seen at least 2 times at a minority-serving metropolitan outpatient rheumatology clinic. Of these patients, 200 (26.5%) also had a lipid panel in the EMR, and rates of obtaining lipid profiles were statistically similar between those patients with high vs normal ESR (29.5% vs 23.5%; P =.06).

A significant difference between high vs normal ESR was seen in LDL-C (94.6mg/dl vs 105.4mg/dl; P =.03). No difference was seen between high vs normal ESR in triglycerides (P =.67), HDL-C (P =.87), and total cholesterol (P =.09). Also, in high vs normal ESR, there was no difference in the prescription rate of lipid-lowering medications (9.9% vs 8.1%; P =.38).

Researchers concluded that, “Among patients with elevated ESR, only 29.5% of patients were evaluated with a lipid profile, and 9.9% of patients were prescribed a lipid-lowering medication.” These results add credence to the lipid paradox among RA patients — LDL being inversely correlated with inflammation. Researchers suggest, “specialized risk evaluation and rigorous management of atherosclerotic CVD with a lipid specialist or preventive cardiologist,” for patients with RA and elevated ESR.

Reference

Aronov A, Kim YJ, Nazir NT. Association of systemic inflammation with lipid profiles and management in patients with rheumatoid arthritis. Presented at: National Lipid Association Scientific Sessions; June 2-5, 2022; Scottsdale, AZ. Abstract #50.