Skip to main content
Download PDF

Assessing the relation between systemic lupus erythematosus and metabolic syndrome in Syria: a cross-sectional study

BMC Rheumatology volume 9, Article number: 2 (2025) Cite this article

Abstract

Background

Systemic Lupus Erythematosus (SLE) affects all organ systems. As a result, fat intake and sedentary life are evident in the modern world. The prevalence of metabolic syndrome, with its components, increased, leading to increased mortality. We aimed to investigate the prevalence of metabolic syndrome in SLE and its relationship with disease activity.

Methods

A cross-sectional study was conducted on 70 SLE patients at Al Mouwasat University Hospitals in Damascus, Syria, between November 2021 and November 2022. The patients were divided into two groups based on the presence or absence of metabolic syndrome. The SLE Disease Activity Index (SLEDAI) was assessed in each group and compared with different disease parameters.

Results

Out of the 70 patients, 65 were females. The mean age was 32.19 ± 7.15 years, and the mean disease duration was 4.4 ± 2.96 years. Metabolic syndrome was found in 32 patients (45.7%). Metabolic syndrome in SLE patients was associated with a higher disease activity index, older age, delayed age at first diagnosis, longer disease duration, higher frequency of renal involvement, and use of cyclophosphamide.

Conclusion

Our study highlights the importance of evaluating and treating metabolic syndrome and its components in patients with SLE, as it may play a role in controlling disease activity. We recommend conducting larger studies in the future to overcome the limitations of this research, such as including a larger number of patients, conducting multicenter studies to generalize the results, and including a healthy control group.

Peer Review reports

Background

Systemic Lupus erythematosus (SLE) is a systemic immune disease that affects almost all organs and tissues. Although (SLE) can affect both genders, it primarily affects women who are in their reproductive age [1]. The course of the disease is characterized by periods of remission and activity. Its pathogenesis is not fully understood; many factors, such as genetic, environmental, and immune, may play a role [2]. As a result of the increase in fat intake and the sedentary life in the modern world, The prevalence of metabolic syndrome, with its components like obesity, hypercholesterolemia, dyslipidemia, and insulin resistance, has increased [3]. The most used definitions of metabolic syndrome were the definition of the World Health Organization (WHO) and the National Cholesterol Education Program Adult Treats of the Met Panel III [4]. The WHO first defined the component of the metabolism disorder [5]. Then, the National Cholesterol Education Program Adult Treats of the met Panel III proposed the following criteria: systolic blood pressure, glucose fasting, triglycerides (TG), high-density lipoprotein (HDL), and waist circumference to define the metabolic syndrome as a presence of the three conditions mentioned above, which, in turn, represented a risk of cardiovascular disease and type 2 diabetes mellitus [4]. The metabolic syndrome causes chronic inflammation due to the release of adipokines from adipocytes) such as tumor necrosis factor (TNF), C-reactive protein (CRP), Interleukin-1 (IL-1), and Interleukin-6 (IL-6)) [6]. At the same time, TNF-α and IL-6 are associated with the activity of the disease in patients with SLE [1], therefore, it is believed that adipokines have an important role in the development of the metabolic syndrome and its relationship to the SLE disease activity [1, 7, 8].

This study aims to reveal the association between SLE and metabolic syndrome, its components, and its relationship with disease activity.

Methods

Study design and participants

This cross-sectional study was conducted on 70 SLE patients. The participants were recruited from the outpatient clinic of Al Mouwasat University Hospital between November 2021 and November 2022. The study was approved by the Ethical Committee of the Faculty of Medicine, Damascus University (NK: 42121/2021). The sample size was 70 patients with a confidence interval of 95% and a predictive value of 0.05. Inclusion criteria include SLE patients older than 18 years diagnosed according to the American College of Rheumatology/European League Against Rheumatism 2019 [9] after signing the confirmed consent. Exclusion criteria include patients with arthritis, rheumatic diseases, other connective tissue lesions, cancer patients, pregnant women, and postpartum periods less than six months. The metabolic syndrome was diagnosed if at least 3 of the five following factors were found: central (body mass index (BMI) > 30 kg/m2) and /or abdominal obesity (waist circumference > 102 cm for men and 88 cm for women, systemic arterial hypertension > 130 × 85 mmHg, fasting blood glucose > 100 mg/dl, hypertriglyceridemia > 150 mg/dl, and levels of HDL cholesterol < 35 mg/dl for men and 45 mg/dl for women, according to the definition of the National Cholesterol Education Program Adult Treats of the met Panel III [1, 2].

Questionnaire

The authors collected the data by administering a validated five-part questionnaire (Supplemental file 1). The first part gathered demographic information such as age, gender, medical and surgical history, and current treatments. It also included questions about the patient’s main complaints, other symptoms, and the duration of the disease.

The second part involved a comprehensive physical examination and laboratory tests. Blood samples were taken after a 12-hour fast to analyze parameters such as fasting blood sugar, lipid profile, complete blood count, urea, creatinine, erythrocyte sedimentation rate, CRP, complements (C3 and C4), and Anti-ds DNA. These samples were analyzed using an automatic analyzer.

Anthropometric measurements were obtained in the third part. Height was measured using a SECA device, and BMI was calculated using height and weight values [10]. Waist circumference was measured using a non-stretching centimeter tape. Blood pressure was measured after a five-minute rest in a sitting position, and the mean of two measurements was recorded.

The fourth part utilized the ACR/EULAR2019 criteria to diagnose SLE. A positive ANA ≥ 1:80 and the presence of 10 points were required for diagnosis [9].

Lastly, the fifth part utilized SLEDAI to assess disease activity. Disease activity was classified based on the number of points, with remission/mild disease being 0–5 points, a moderate disease being 6–10 points, and severe disease being > 10 points. Patients were diagnosed with lupus nephritis if their renal SLEDAI score was > 8 [11].

The SLE patients were divided into two groups: SLE patients with metabolic syndrome and SLE patients without metabolic syndrome; then every group was divided according to the disease activity index into three subgroups: 1- patients with remission/mild disease: SLEDAI < 5, 2- patients with moderate activity: 6 ≤ SLEDAI ≤ 10, 3- patients with severe active disease: SLEDAI > 10.

Statistical analysis

The data was converted to a computer database using Excel 2016, and the data were analyzed using the SPSS statistical analysis program (version 25). Data analysis was performed using frequency, percentage, standard deviation, and mean. A descriptive study was conducted to assess the study’s indicators. The data was represented in tables and charts, which facilitated their understanding. ACR/EULAR2019 criteria were calculated, where every SLEDAI was calculated. The Chi-Square independence test was used to test the independence of qualitative variables. The variable was considered statistically significant when the significance level P value was less than 0.05.

Results

Sample characteristics

The study sample consisted of 70 patients, with a mean age of 32.19 ± 7.15 years, ranging from 19 to 45 years, and included 5 (7.1%) males and 65 (92.9%) females. The mean age when SLE was diagnosed was 27.79 ± 4.98 years, ranging from 18 to 37 years. The disease duration was 4.4 ± 2.96 years, ranging from 1 to 11 years. The musculoskeletal manifestations were the most frequent in SLE patients. 90% of patients were under steroid treatment, whereby 77.1% of patients took hydroxychloroquine (Table 1).

Table 1 Sample characteristics
Full size table

The average systolic pressure in the sample patients was 133.43 ± 20.21 mm Hg, and the average diastolic pressure was 82.71 ± 11.12 mm Hg. While the average waist circumference of the research sample was 87.76 ± 5.57 cm, and the values ranged between 79 and 104 cm. The number of patients with metabolic syndrome in the research was 32 patients, with a prevalence of 45.7%. Regarding SLEDAI, 21(30%) of patients had remitted disease, and 33(47.1%) patients had moderate activity disease (Table 2).

Table 2 The presence of metabolic syndrome and distribution of SLEDAI among patients
Full size table

Characteristics of metabolic syndrome among SLE patients

By using the student t-test, there was a statistically significant difference (P-value < 0.001) in the mean age of 32 SLE patients with metabolic syndrome (36.09 ± 6.02 years) and 38 SLE patients without metabolic syndrome (28.89 ± 6.37). In addition, 62.5% of SLE patients with metabolic syndrome had a positive history of parents with obesity. In comparison, 37.5% of SLE patients without metabolic syndrome had a positive history of parents with obesity (P < 0.001). In the clinical manifestations of SLE, there was a statistically significant difference between renal injury and the presence of metabolic syndrome (P = 0.012) by using Pearson Chi-Square. Whereas renal injury was found in 71.9% of patients with metabolic syndrome, compared to 42.1% in patients without metabolic syndrome, confirmed with renal biopsy that related the renal injury to SLE, according to glomerulonephritis. As for the rest of the clinical manifestations, there was no statistically significant difference between the presence and absence of metabolic syndrome (Table 3).

Table 3 Clinical manifestations of systemic lupus erythematosus between 2 groups
Full size table

For most treatments, there was no statistically significant difference between the presence and absence of metabolic syndrome (Table 4).

Table 4 Treatment in SLE with MS group and SLE without MS group
Full size table

An independent test was conducted to determine the statistical significance of these differences in each part of the metabolic syndrome. Thus, using the Independent Samples T- Test, there are statistically significant differences between the two groups in all components of the metabolic syndrome (Table 5).

Table 5 Comparison of the characteristics of the components of the metabolic syndrome between the two groups of patients
Full size table

Multivariate logistic regression

There was a statistically significant indication that factors including age, age when SLE was diagnosed, renal involvement, GLU, TG, HDL, and BMI can predict metabolic syndrome with p-values 0.002, 0.002, 0.04, 0.018, 0.002, 0.005, and 0.019 respectively; in contrast, Cyclophosphamide did not have a significant relationship with metabolic syndrome with a p-value of 0.93 (Table 6).

Table 6 Multivariate logistic regression
Full size table

Association between MS and SLEDAI

The SLEDAI score in both groups is determined by the presence of the metabolic syndrome. To find out the statistical significance of these differences, a chi-square test (X2-test) was performed, and a statistically significant relationship was found between the metabolic syndrome and SLEDAI, where SLE patients with the metabolic syndrome had a greater frequency of highly active disease compared to SLE patients without the metabolic syndrome. P-value = 0.025 < 0.05.

Discussion

The prevalence of metabolic syndrome among SLE patients was 45.7%, which is higher compared to other studies conducted in China (34.2%), Egypt (36.9%), and Australia (29%) [12,13,14]. These differences in prevalence rates can be attributed to various factors such as racial diversity, genetic factors, lifestyle, and dietary habits, as well as variations in the criteria used to diagnose metabolic syndrome [8]. In addition, the bordering nations of Syria have varying rates of metabolic syndrome prevalence. Jordan has the highest percentage (51%) [15], followed by Iraq (39.4%) [16], Lebanon (31.2%) [17], Palestine (23%), and Turkey being the lowest one with (17.9%) [18]. In terms of the components of metabolic syndrome, low HDL and hypertension were the most frequent components among SLE patients, 84% and 72%, respectively [19]. These findings were consistent with the Egyptian study but differed from the Australian and Turkish studies, where hypertension was the most common component at 59% and 38.6%, respectively [14, 20].

This study revealed a significant association between metabolic syndrome in SLE patients and older age, later age at diagnosis, and increased disease duration. These associations may be explained by the increased risk of diabetes and hypertension with age, as well as chronic exposure to inflammatory mechanisms and SLE therapies [19, 21]. Hammam et al. study showed that metabolic syndrome is associated with advanced age and later age at diagnosis but without a significant association with the duration of the disease [19]. Contrary to the above, the study of Jin et al. did not find any statistically significant relationship between metabolic syndrome, age, and disease duration [22].

Furthermore, our study showed a significant association between metabolic syndrome and renal injury, which was consistent with other studies. Patients with metabolic syndrome have a high risk of developing renal injury and renal insufficiency, even in the absence of diabetes. This may be due to increased connective tissue growth and the secretion of adipokines in metabolic syndrome, which can contribute to microvascular damage and fibrosis in the kidney [23, 24]. Jin et al. showed a significant association between metabolic syndrome and renal injury in addition to arthritis [22]. However, Hammam et al. did not find a significant association with renal injury, but they did find that neuropsychiatric manifestations were associated with metabolic syndrome [18].

No significant association was observed between the use of cyclophosphamide, a treatment for SLE, and the presence of metabolic syndrome. SLE patients with metabolic syndrome were more likely to receive cyclophosphamide compared to those without metabolic syndrome. This finding was in contrast with studies conducted in Brazil and Egypt [19, 23]. The higher incidence of kidney injury in SLE patients with metabolic syndrome may explain the increased use of cyclophosphamide in this group, as this medication is commonly used to treat acute lupus nephritis, a kidney complication associated with SLE.

Even though antimalarials have lipid-lowering and anti-inflammatory properties [25], our study did not find any statistically significant difference in their usage between the two groups of patients. This finding is consistent with some previous studies [19, 21]. However, a study by Medeiros et al. found that using antimalarials has a protective effect against the development of metabolic syndrome [23].

The same applies to corticosteroids despite their known role in increasing cholesterol levels, obesity, and high arterial tension. Our study did not find a significant association between their use and the development of metabolic syndrome, which is consistent with some studies [14, 19] but different from others that found a significant association only when prednisolone was given in a daily dose greater than 10 mg [21, 23]. A study by Demir et al. also found no significant association between metabolic syndrome and the treatments used for SLE.(20) Some studies suggest that the relationship between the effects of prednisolone and the protective effects of hydroxychloroquine on metabolic disorders is complex, as an increase in the lipid-lowering effect of hydroxychloroquine was observed in SLE patients receiving corticosteroid treatment and a lower cholesterol-raising effect of corticosteroids was observed in SLE patients receiving antimalarial treatment [13].

The study also found a significant relationship between metabolic syndrome and disease activity in SLE patients. Those with metabolic syndrome had a higher frequency of highly active disease than those without, which is consistent with some studies [19, 22,23,24]. However, one study found no correlation between disease activity and metabolic syndrome [21].

Study’s limitations

The study had several limitations, including its cross-sectional design, which only suggests correlations rather than establishing causality. Additionally, the study was limited to participants from one center, which may restrict the generalizability of the findings. Furthermore, due to the small sample size of the subgroups, the study did not analyze environmental factors such as socioeconomic status, nutrition, and sedentary lifestyle between the two groups.

Strengths of the study

This study’s insights on the connection between SLE and metabolic syndrome in a limited geographical setting are significant. A cross-sectional approach was adopted, which helps to understand existing within-patient associations and the prevalence of metabolic syndrome among SLE patients accessing healthcare services in Syria. The research also applies a stringent methodology encompassing well-defined diagnostic tools and a comprehensive assessment of metabolic aspects, making the results trustworthy. Moreover, this study focuses on an underrepresented group of individuals in previous research, providing new insights into the health risks experienced by people with lupus in Syria and thus necessitating tailored strategies for managing autoimmune illnesses and obesity. Eventually, this investigation is expected to lead to better public health policies and clinical practices due to improved outcomes for patients in this area.

Conclusion

The prevalence of metabolic syndrome among SLE patients was 45.7%. The most frequent components of metabolic syndrome among SLE patients were Low HDL and hypertension. This study found a significant relationship between metabolic syndrome and age, age at diagnosis, hyperglycemia, and mainly having renal affection in SLE patients; in contrast, Cyclophosphamide did not have a significant relationship with metabolic syndrome. Our research findings highlight the importance of assessing and managing metabolic syndrome and its components in individuals with SLE in order to regulate disease activity.

Data availability

The data supporting this study’s findings are available from the Corresponding author upon reasonable request.

Abbreviations

SLE:

Systemic lupus erythematosus

SLEDAI:

The SLE disease activity index

WHO:

World Health Organization

TG:

Triglycerides

HDL:

High-density lipoprotein

TNF:

Tumor necrosis factor

CRP:

C-reactive protein

IL-1:

Interleukin-1

IL-6:

Interleukin-6

BMI:

Body mass index

References

  1. Abdalhadi S, Khalayli N, Al-Ghotani B, Kudsi M. Systemic lupus erythematosus disease activity and neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: a cross-sectional case–control study. Ann Med Surg (Lond). 2023;85(5):1448–53.

    Article  PubMed  Google Scholar 

  2. Mok CC. The Jakinibs in systemic lupus erythematosus: progress and prospects. Expert Opin Investig Drugs. 2019;28(1):85–92.

    Article  CAS  PubMed  Google Scholar 

  3. Metabolic Syndrome: Updates on Pathophysiology and Management in 2021 - PMC [Internet]. [cited 2023 Jul 22]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775991/

  4. Huang Y, Chen Z, Wang X, Zheng C, Shao L, Tian Y, et al. Comparison of the three most commonly used metabolic syndrome definitions in the Chinese Population: a prospective study. Metabolites. 2023;13(1):12.

    Article  CAS  Google Scholar 

  5. Ananthy V, Priyadharsini RP, Subramanian U. Pathogenesis, diagnosis, and management of metabolic syndrome: a comprehensive review. SBV J Basic Clin Appl Health Sci. 2021;4(2):39–45.

    Article  Google Scholar 

  6. K Z, O JD, D Ś, M R, M M. Adipokines and Obesity. Potential link to metabolic disorders and chronic complications. International journal of molecular sciences [Internet]. 2020 May 18 [cited 2023 Jul 22];21(10). Available from: https://pubmed.ncbi.nlm.nih.gov/32443588/

  7. Gigante A, Iannazzo F, Navarini L, Sgariglia MC, Margiotta DPE, Vaiarello V, et al. Metabolic syndrome and adipokine levels in systemic lupus erythematosus and systemic sclerosis. Clin Rheumatol. 2021;40(10):4253–8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Medina G, Vera-Lastra O, Peralta-Amaro AL, Jiménez-Arellano MP, Saavedra MA, Cruz-Domínguez MP, et al. Metabolic syndrome, autoimmunity and rheumatic diseases. Pharmacol Res. 2018;133:277–88.

    Article  CAS  PubMed  Google Scholar 

  9. Aringer M, Costenbader KH, Daikh DI, Brinks R, Mosca M, Ramsey-Goldman R, et al. 2019 EULAR/ACR classification criteria for systemic Lupus Erythematosus. Arthritis Rheumatol. 2019;71(9):1400–12.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ko Y, Choi S, Won J, Lee YK, Kim DH, Lee SK. Differences in accuracy of height, weight, and body mass index between self-reported and measured using the 2018 Korea Community Health Survey data. Epidemiol Health. 2022;44:e2022024.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002;29(2):288–91.

    PubMed  Google Scholar 

  12. Liu S-Y, Han L-S, Guo J-Y, Zheng Z-H, Li H, Zhang L, Zhang X, He Y-J, Gao G-M, Liu Z-S, Zeng X-F. Metabolic syndrome in Chinese patients with systemic lupus erythematosus: no association with plasma cortisol level 2013. [Internet]. [cited 2023 Jul 22]. Available from: https://journals.sagepub.com/doi/10.1177/0961203313478301?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

  13. Gheita TA, Raafat HA, Sayed S, El-Fishawy H, Nasrallah MM, Abdel-Rasheed E. Metabolic syndrome and insulin resistance comorbidity in systemic lupus erythematosus. Effect on carotid intima-media thickness. Z Rheumatol. 2013;72(2):172–7.

    Article  CAS  PubMed  Google Scholar 

  14. Apostolopoulos D, Vincent F, Hoi A, Morand E. Associations of metabolic syndrome in SLE. Lupus Sci Med. 2020;7(1):e000436.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Obeidat AA, Ahmad MN, Haddad FH, Azzeh FS. Alarming high prevalence of metabolic syndrome among Jordanian adults. Pak J Med Sci. 2015;31(6):1377–82.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pengpid S, Peltzer K. Prevalence and associated factors of metabolic syndrome among a national population-based sample of 18–108-year-olds in Iraq: results of the 2015 STEPS survey. Int J Diabetes Dev Ctries. 2021;41(3):427–34.

    Article  Google Scholar 

  17. Sibai AM, Obeid O, Batal M, Adra N, Khoury DE, Hwalla N. Prevalence and correlates of metabolic syndrome in an adult Lebanese population. CVD Prev Control. 2008;3(2):83–90.

    Google Scholar 

  18. Ansarimoghaddam A, Adineh HA, Zareban I, Iranpour S, HosseinZadeh A, Kh F. Prevalence of metabolic syndrome in Middle-East countries: Meta-analysis of cross-sectional studies. Diabetes Metab Syndr. 2018;12(2):195–201.

    Article  PubMed  Google Scholar 

  19. Hammam N, Rashad SM, Mohamed AAA. Metabolic syndrome in systemic lupus erythematosus patients: relationship to disease activity and neuropsychiatric lupus. Z Rheumatol. 2018;77(10):938–45.

    Article  CAS  PubMed  Google Scholar 

  20. Demir S, Artim-Esen B, Şahinkaya Y, Pehlivan Ö, Alpay-Kanıtez N, Omma A, et al. Metabolic syndrome is not only a risk factor for cardiovascular diseases in systemic lupus erythematosus but is also associated with cumulative organ damage: a cross-sectional analysis of 311 patients. Lupus. 2016;25(2):177–84.

    Article  CAS  PubMed  Google Scholar 

  21. Negrón A, Molina M, Mayor A, Rodriguez V, Vilá L. Factors associated with metabolic syndrome in patients with systemic lupus erythematosus from Puerto Rico. Lupus. 2008;17(4):348–54.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jin LR, Tao MJ, Zhou J, Xu L, Li Q, Li Z, et al. Metabolic syndrome in systemic lupus erythematosus was closely related to body mass index, blood pressure, blood sugar, blood lipids, and arthritis. Pak J Med Sci. 2020;36(6):1220–7.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Medeiros MM das C, Xavier, de Oliveira ÍM, Ribeiro ÁTM. Prevalence of metabolic syndrome in a cohort of systemic lupus erythematosus patients from northeastern Brazil: association with disease activity, nephritis, smoking, and age. Rheumatol Int. 2016;36(1):117–24.

  24. Parker B, Urowitz MB, Gladman DD, Lunt M, Bae SC, Sanchez-Guerrero J, et al. Clinical associations of the metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis. 2013;72(8):1308–14.

    Article  PubMed  Google Scholar 

  25. Corica D, Aversa T, Valenzise M, Messina MF, Alibrandi A, De Luca F, et al. Does Family history of obesity, Cardiovascular, and metabolic diseases Influence Onset and Severity of Childhood obesity? Front Endocrinol (Lausanne). 2018;9:187.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

The authors declare that no external funding was received for this study from public, commercial, or non-profit organizations.

Author information

Authors and Affiliations

  1. Rheumatology Department, Damascus University, Damascus, Syria

    Noura Mallouhi & Mayssoun Kudsi

  2. Diagnostic Radiology Department, Damascus University, Damascus, Syria

    Ahmad Nabil Alhouri

  3. Psychiatry Department, Damascus University, Damascus, Syria

    Naram Khalayli

  4. Internal Medicine Department, Damascus University, Damascus, Syria

    Hasan Nabil Alhouri

  5. Endocrinology Department, Damascus University, Damascus, Syria

    Younes Kabalan

Authors
  1. Noura Mallouhi
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Ahmad Nabil Alhouri
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Naram Khalayli
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Hasan Nabil Alhouri
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Mayssoun Kudsi
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Younes Kabalan
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

Noura Mallouhi: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; resources; writing—original draft. Ahmad Nabil Alhouri: Methodology; project administration; resources; validation; visualization; writing—original draft; writing— review and editing. Naram Khalayli: Data curation; investigation; writing—original draft. Hasan Al Houri: Methodology; validation; visualization; writing—original draft; writing— review and editing. Mayssoun Kudsi: Supervision. Younes Kabalan: Supervision.

Corresponding author

Correspondence to Ahmad Nabil Alhouri.

Ethics declarations

Ethical approval

Ethical approval was obtained from the Institutional Review Board (IRB: DB,7683,2022), Faculty of Medicine, Damascus University. Informed consent was obtained from the patients who agreed to participate in the study.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mallouhi, N., Alhouri, A.N., Khalayli, N. et al. Assessing the relation between systemic lupus erythematosus and metabolic syndrome in Syria: a cross-sectional study. BMC Rheumatol 9, 2 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s41927-024-00453-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s41927-024-00453-z

Keywords

BMC Rheumatology

ISSN: 2520-1026

Contact us