Background/Purpose:

Whether glucose metabolism is abnormal in patients affected by inflammatory arthritis is controversial. In the present study, we aimed to evaluate glucose metabolism in a cohort of rheumatic patients with respect to matched controls.

Methods:

We prospectively recruited patients affected by inflammatory arthritis followed-up at our Immunorheumatology Unit. We selected two sex-age and BMI matched controls from a cohort of patients who underwent an Oral Glucose Tolerance Test (OGTT) in our Metabolic Unit. Rheumatologic diagnosis were based on ACR/EULAR 2010 classification criteria for Rheumatoid Arthritis (RA), CASPAR criteria for Psoriatic Arthritis (PsA) and ASAS Criteria for Spondyloarthritis (SpA). 

Results:

The study population includes 97 cases (F=68, 70.1%) affected by RA (N=53, 54.6%), PsA, (N=35, 36.1%) or other SpA, (N=9, 9.3%) and 194 matched controls. Cases and controls were similar with regard to age, BMI, waist circumference (WC) and rate of arterial hypertension. We could not detect any difference between case and controls in glucose and insulin plasma concentration neither at baseline nor after OGTT. HOMA was similar in the two groups as well as Glycated haemoglobin (HbA1C).

In the group of cases C-Reactive Protein (CRP) was directly related to: plasma glucose at baseline (G0; p=0.0005); plasma glucose after OGTT (G120; p=0.0002); insulin plasma concentration after OGTT (I120’; p=0.006); HbA1C (p=0.02). Erythrocyte sedimentation rate (ESR) was directly related to: G0 (p=0.02); G120; p=0.002; HbA1C (p=0.03).

We then focused our attention on RA patients. According to DAS28-ESR, 33 patients were in remission, while 18 showed a residual disease activity. CRP was still correlated to G0, G120 and HbA1C even in patients with a DAS28<2.6; anyway in a multivariate regression model the only independent predictor of all these variables was BMI. In fact patients with a pathological BMI had also a significantly higher CRP (0.33 [0.15-0.60]) than people with a normal BMI (0.16 [0.06-0.43]); p=0.04. In patients with residual disease activity DAS28 was linked to I0 (p=0.034, as well as ESR (p=0.004); ESR was also directly related to HOMA (p=0.002). in multivariate regression model ESR was a predictor of HOMA (p=0.003), as well as BMI and WC, independently by cumulative steroid dose.

Conclusion:

In patients with rheumatic disease, glucose metabolism is not different from general population if remission has been achieved. However, among patients with residual activity ESR is a strong predictor of insulin resistance, suggesting that the inflammatory state induced by the rheumatic condition may represent a factor in the development of an altered glucose metabolism.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-glucose-metabolism-in-rheumatic-patients-a-case-control-study/