MỐI TƯƠNG QUAN GIỮA NỒNG ĐỘ LIPID MÁU VÀ MỨC ĐỘ HOẠT ĐỘNG BỆNH Ở BỆNH NHÂN VIÊM KHỚP DẠNG THẤP

Abstract

Background: Patients with rheumatoid arthritis (RA) have a 1,5 to 2 times higher risk of cardiovascular events compared to the general population. However, the correlation between blood lipid levels and cardiovascular risk in these patients is complex due to the “lipid paradox,” which can lead traditional lipid-based risk calculators to underestimate the actual risk.

Objectives: To investigate the correlation between blood lipid levels and disease activity (using the DAS28-ESR score) in patients with RA.

Methods: A cross-sectional descriptive study was conducted on 40 RA patients diagnosed under the ACR/EULAR 2010 criteria at the Rheumatology Department of Cho Ray Hospital from January 2026 to June 2026. Patients concurrently diagnosed with other autoimmune diseases, receiving lipid-lowering therapies, or taking prednisone ≥ 7,5 mg/day were excluded. Disease activity (DAS28-ESR) and fasting lipid profiles including total cholesterol (TC), LDL-c, and HDL-c were evaluated. The correlation between disease activity and lipid profiles was analyzed using Pearson’s for normally distributed variables and Spearman’s correlation for non-normally distributed variables.

Results: Among the 40 patients, females accounted for the majority (87,5%), with a mean age of 59,69 ± 11,53 years and a median disease duration of 10,0 (2,25 – 15,75) years. The mean DAS28-ESR was 3,08 ± 1,2. The mean concentrations of TC, LDL-c, and HDL-c were 196,45 ± 38,17; 121,27 ± 30,28; and 53,18 ± 12,72 (mg/dL), respectively. There was a statistically significant inverse correlation between DAS28-ESR and TC (r = -0,345; p = 0,029), LDL-c (r = -0,412; p = 0,008), with the strongest correlation observed with HDL-c (r = -0,469; p = 0,002).

Conclusions: The “lipid paradox” is clearly evident in RA patients, demonstrated by an inverse correlation between disease activity and lipid profiles. Low circulating lipid levels during periods of high disease activity do not equate to a normal lipid metabolic state. Therefore, cautious interpretation of lipid profiles in this patient population is crucial and should always be evaluated in close correlation with their current systemic inflammatory status.