Background/Purpose: High levels of inflammatory cytokines are associated with insulin resistance syndrome in long-standing AR. The aim was to analyze insulin resistance (IR), adipokines, inflammatory cytokines and baseline clinical and laboratory features in patients with early rheumatoid arthritis (ERA) who have not received any treatment for their underlying disease.

Methods: Cross-sectional, case-control, study. Forty-six consecutively patients with ERA (disease duration <1 year) according to 2010 ACR/EULAR criteria, older than 16 years of age and 45 sex and age-matched controls were included. Patients with Diabetes (2010 ADA Criteria) and in prior or current treatment with DMARDs or corticosteroids were excluded. All participants signed an informed consent. Baseline blood and urine samples were collected; Glucose, lipid profile, RF, anti-CCP, ESR, CRP and other parameters were measured in fresh samples; serum was stored at -80°C for later analysis of insulin, ultrasensitive CRP, IL6, TNFα, resistin, adiponectin y leptin. Insuline resistance was estimated by the Homeostasis model assesment for insulin resistance (HOMA-IR), HOMA β, McAuley and QUICKI index. A cardiovascular risk factors (CVRF) questionnaire and a dietary survey were also completed. Measurement of abdominal and hip circumference was performed. Statistical analysis: T-test or Mann Whitney test and Pearson or Spearson´s correlation analysis were performed.

Results: Among 103 subjects twelve were excluded (6 were other types of arthritis, 6 had type 2 diabetes) and finally, 91 subjects were included; 46 had RA (50.5%) and 45 were healthy controls (49.5%). Most of them were women (~76%) and there were not differences in age, sex and BMI, between groups but hypertension was higher in patients than controls (30 vs 13%, p < 0.05). Regarding baseline characteristics of patients with RA, the average time of evolution of RA was 6 months, and more than 70% had positive RF and anti-CCP. Concerning laboratory parameters, CRP and ESR were higher in RA patients than in controls (p<0,001). In relation to CVRF and IR, total cholesterol was higher in controls [215 (SD±40,3) mg/dl vs 195(SD±39,5) mg/dl (p< 0,05) ], and HDL cholesterol lower in RA patients [52(SD±14,8)mg/dl Vs 59 (SD±16,7) mg/dl(p< 0,05)], and also levels of cytokines such as IL6, TNF-alpha and Resistin in blood were higher in patients than controls. No statistically significant differences were found in leptin, adiponectin or atherogenic index between cases and controls neither in insulin resistance estimated by HOMA-RI, HOMA β ,QUICKI nor McAuley. Bivariate analysis revealed a statistically significant correlation between the different indices of IR and parameters of inflammatory activity (PCR, TNF), leptin and body composition.

Conclusion: Although patients showed higher blood pressure, total cholesterol and resistin levels and lower HDL cholesterol than age, sex and BMI matched controls, we were unable to show differences in leptin, adiponectin and any of the insulin resistance indexes assessed, in spite of the expected high levels of systemic inflammatory molecules, such as TNFα and IL-6 in patients group.  Lack of association between AR and IR indexes might be due to the short course of the disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/baseline-evaluation-of-insulin-resistance-in-patients-with-early-non-treated-rheumatoid-arthritis/