Background/Purpose: To analyze treatment effects over insulin resistance (IR), adipokines, inflammatory cytokines and clinical and laboratory characteristics in patients with early rheumatoid arthritis (RA).

Methods: A 6 month prospective longitudinal observational cohort study. Patients with early untreated RA (disease duration <1 year) according to 2010 ACR/EULAR criteria, in follow-up by Rheumatology service of HRU Carlos Haya of Málaga(Spain) were included. After a baseline blood test, treatment for RA was initiated. At six months, another blood test was done. Exclusion criteria: Patients with Diabetes (2010 ADA Criteria) or patients in treatment with glucocorticoids or DMARDs were excluded. All subjects provided written informed consent. Outcome 1º: changes in Insulin Resistance (IR),after starting treatment for RA,estimated by the Homeostasis Model Aassesment for insulin resistance (HOMA-IR), by HOMA β, McAuley and by QUICKI index. Secondary Variables:Changes in the follow variables:Glucose, lipid profile,blood pressure, RF, antiCCP and  ESR were measured. Insulin,CRP, IL6, TNFα,resistin, adiponectin, and leptin were determined in frozen serum stored at -80°C.  Measurement of waist and hip circumference was performed. Statistical analysis:  Baseline comparisons between groups were performed using Chi-square, T-test or Mann Whitney test. To analyse the changes Mc Nemar, paired sample T-Test  and Wilcoxon tests were used. Multiple linear regression was carried out. 

Results: A total of 103 subjects were investigated.12 were excluded (6 other types of arthritis,6 Diabetics) and finally, 91 subjects were included in the study; 46 RA and 45 healthy controls. Most of them were women (76.1% in RA). Cases and controls were similar in age, sex and BMI. Regarding baseline characteristics of patients with RA, the mean time duration of RA was 5.9 (SD± 3.5) months, and more than 70% of patients had positive RF and/or AntiCCP. CRP and ESR were higher in RA patients than in controls (p<0,001). In baseline evaluation no differences were found in IR estimated by different index. In multiple linear regression noted a positive correlation between HOMA IR and AR evolution time to diagnosis.After baseline evaluation, all patients were treated with DMARDs. After 6 month of follow–up, a non-significant increase in BMI was observed. The blood pressure and the metabolic characteristics, including lipid profile, fasting glucose, fasting insulin, HOMA-IR, HOMA-B, and QUICKI, remained steady. However, an improvement was observed in all variables related with activity index: hsCRP(12.3 Vs5.6), ESR(32.9(21.4)Vs 18.7(12.0), joint counts, patient’s assessment of disease, DAS28(5.5(1.3)Vs3.2(1.4)), and HAQ(1.3(0.7)Vs 0.548(0.567)) with (p<0.001). Both cytokines and adipokines decreased after the treatment. 

Conclusion: The patients with untreated early RA still do not show insulin resistant observed in patients with established RA despite having high levels of activity index a inflammatory cytokines. Lack of association in baseline evaluation between AR and IR indexes might be due to the short course of the disease but after six months of follow up, we do not find IR which could be due to inflammatory activity is controlled in most of them.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-treatment-effect-over-insulin-resistance-and-adipokines-in-patients-with-early-rheumatoid-arthritis-a-6-months-longitudinal-observational-study/