Background/Purpose: Rheumatoid arthritis (RA) is a systemic disease that manifests mainly with articular symptoms, but the main cause of death is cardiovascular disease (CVD). Chronic inflammation is thought to contribute both directly to CVD as well as indirectly to cardiometabolic risk factors such as insulin resistance, atherogenic lipid profile and sarcopenic obesity, all features of chronic active RA. Data on the presence of these risk factors in newly diagnosed RA are scarce but need to be defined so that they can be addressed if present in early disease. The aim of the present study was to examine the association of disease activity with cardiometabolic risk factors in newly diagnosed RA.

Methods: Patients are participants in an ongoing study that compares the effect of a treat to target strategy vs. usual care on cardiometabolic comorbidities in RA. For the present study, baseline patient data were analyzed in a cross-sectional design. Participants had RA based on 2010 ACR classification criteria  with symptoms < 2 years; were DMARD and biologic-naïve (except hydroxychloroquine); took corticosteroid equivalent of prednisone ≤10 mg daily; had clinical disease activity index >10, and did not have known diabetes. Disease activity was assessed by the disease activity score (DAS)28 and disability by the Modified Health Assessment Questionnaire (MHAQ). The primary outcome was insulin resistance as assessed by the 2 hour glucose tolerance test (GTT). Secondary outcomes were high density lipoprotein cholesterol (HDL-c) and body composition measurements by DXA (Hologic), including android/gynecoid ratio, appendicular lean mass (kg/m²) and appendicular lean mass/height². The associations between DAS28 and MHAQ with the outcome variables were evaluated using linear regression analysis, both unadjusted and adjusted for age, gender and BMI. All outcome variables were analyzed as continuous. Pearson’s partial correlation coefficient was used to estimate the strength of the associations.

Results: Of the 33 participants, 64% were female, with mean age 50 years, 70% RF positive, 53% ACPA positive, with median BMI 30.3 kg/m² and median DAS28 4.5. In the unadjusted model, DAS28 was positively associated with insulin resistance (p=0.01). In the adjusted model, the Pearson partial correlation was 0.3777 (p = 0.05). There was no association of the DAS28 with HDL or body composition measures. MHAQ was inversely associated with HDL (p= 0.05) in the unadjusted analysis but this association lost significance in the adjusted model. There was no association of the MHAQ with insulin resistance or body composition measures. As expected, age and female gender were inversely associated with appendicular lean mass.

Conclusion: In early RA, higher disease activity was associated with increased insulin resistance, a risk factor for CVD. Our findings underscore the importance of addressing cardiometabolic comorbidities in early RA to minimize disease-related morbidity and mortality.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disease-activity-is-associated-with-insulin-resistance-in-early-rheumatoid-arthritis/