Background Dyslipidemia has been implicated in a variety of musculoskeletal disease including rheumatoid arthritis (RA). Evidence is emerging that there might be a pathogenic interaction among inflammation, dyslipidemia, and adipokines.

Objectives We prospectively investigated the association of cumulative lipid levels with radiographic progression.

Methods Two hundred-forty two RA patients regularly underwent plasma cholesterol assessment at four-time visits. Disease activity parameters, including ESR, CRP, DAS28, and hands/feet X-rays were also serially monitored in these patients. The cumulative inflammatory burden and lipid levels were estimated by the time-integrated value. Serum leptin and adiponectin concentrations were determined by ELISA.

Results When patients were divided into three groups according to time-integrated lipid levels, 3^rd tertile of LDL cholesterol and/or triglyceride had persistently higher ESR and CRP levels. In parallel, a more rapid radiographic progression over 2 years was observed in patients with higher LDL cholesterol and/or triglyceride. In multivariate analysis, time-integrated LDL cholesterol was independently associated with the radiographic progression after adjustments for potential confounders. Particularly, the risk of radiographic progression was 5.6-fold in a subgroup with both 3^rd tertiles of LDL cholesterol and triglyceride. Moreover, LDL cholesterol synergistically increased the adjusted probability of radiographic progression in patients with high serum leptin levels, but not in those without.

Conclusions Our data demonstrate that LDL cholesterolemia is a novel serum marker to predict radiographic progression of RA, which seems to be related to circulatory leptin levels. We suggest that a personalized and more aggressive anti-rheumatic therapy is required for dyslipidemic subgroups in RA patients.

Disclosure of Interest None Declared