Metabolic syndrome and systemic lupus erythematosus: the connection.
Chi Chiu MokPublished in: Expert review of clinical immunology (2019)
Introduction: The metabolic syndrome (MetS) is now recognized as a chronic proinflammatory and prothrombotic state that aggravates insulin resistance, oxidative injury, and cardiovascular risk. MetS is more prevalent in patients with systemic lupus erythematosus (SLE), a prototype of systemic autoimmune disease associated with premature atherosclerosis that cannot be accounted by traditional vascular risk factors alone. Dysregulation of the cytokines and adipokines is a common feature in both SLE and MetS, suggesting a complex relationship among autoimmunity, obesity, inflammation, and atherosclerosis. Areas covered: This review summarizes the prevalence of MetS and its effect on cardiovascular outcome and organ damage in patients with SLE. The pathophysiology of MetS and its relevance to SLE is also briefly discussed. Expert opinion: Imbalance of adipokine production in MetS contributes to inflammation and atherosclerosis. MetS predisposes SLE patients to new cardiovascular events and vascular mortality, as well as the development of chronic kidney disease and diabetes mellitus. However, conflicting results have been reported in the literature regarding the levels of the proinflammatory leptin and anti-inflammatory adiponectin, and their relationship with disease activity in SLE patients. While lifestyle modifications and targeting dyslipidemia, hypertension and diabetes mellitus is essential, there is little information on the efficacy and safety of metformin and hydroxychloroquine in alleviating insulin resistance in SLE or MetS. Further research on adipokines in SLE and the role of anti-obesity medications and probiotics in MetS is necessary.
Keyphrases
- systemic lupus erythematosus
- disease activity
- metabolic syndrome
- insulin resistance
- end stage renal disease
- chronic kidney disease
- cardiovascular events
- rheumatoid arthritis
- rheumatoid arthritis patients
- risk factors
- cardiovascular disease
- ankylosing spondylitis
- oxidative stress
- juvenile idiopathic arthritis
- peritoneal dialysis
- type diabetes
- high fat diet induced
- blood pressure
- prognostic factors
- uric acid
- ejection fraction
- systematic review
- weight loss
- coronary artery disease
- high fat diet
- multiple sclerosis
- adipose tissue
- machine learning
- glycemic control
- drug delivery
- healthcare
- polycystic ovary syndrome
- cancer therapy