Insulin Resistance As A Risk Factor For Subclinical Atherosclerosis In Rheumatoid Arthritis

Adel M. Elsayed¹, Samah A. El Bakry¹, S. A. M. Hassan¹, Rehab A. Rahman², Rania A. Abo-Shady³ and Nouran Abaza⁴, ¹Rheumatology Division of Internal medicine department, Ain Shams University, Cairo, Egypt, ²Radiology department, Ain Shams University, Cairo, Egypt, ³clinical pathology, Ain Shams University, Cairo, Egypt, ⁴Physical medicine, Rheumatology and Rehabilitation, Lecturer of Physical medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Atherosclerosis, insulin resistance and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects I: Comorbidities in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Insulin resistance (IR) is a state in which a high insulin concentration is associated with an inadequate response to glucose with normal or high levels of glycaemia. It is strongly associated with systemic inflammation. IR is known to be increased in patients with established rheumatoid arthritis (RA) and has been shown to be a risk factor for both clinical CVD and subclinical atherosclerosis. The aim of this study is to estimate the prevalence of IR among RA patients and its relation to disease activity and disease duration.

Methods:

Forty RA patients and 10 age and sex matched healthy individuals as controls were included. RA patients were fulfilling the 2010 ACR/EULAR diagnostic criteria for RA. Patients with Diabetes mellitus, Obesity and Hypertension were excluded. For all, detailed medical history and thorough examinations were performed. Fasting plasma sugar and fasting serum insulin were done, RA disease activity assessed using DAS28-ESR score and IR was evaluated by the homeostasis model assessment (HOMA2). Carotid artery intima media thickness (IMT) was evaluated using ultrasound.

Results: RA patients had significantly higher ESR, CRP positivity, fasting plasma sugar and fasting serum insulin, HOMA2-IR levels than the controls. Insulin resistance as defined by HOMA2-IR>1 was seen in 33(82.5%) RA patients while it was present in only one (10%) of the controls (p=0.001). RA patients with insulin resistance have significantly longer disease duration (p=0.003), higher disease activity (p=0.000), greater carotid IMT (p=0.000), and have more carotid plaques (p=0.043) than those without insulin resistance. Dividing the RA patients according to the cut-off IMT value (0.72 mm), a significant difference was detected in disease duration (p=0.002) , DAS28 score (p=0.000) and HOMA2-IR (p=0.000) being higher in RA patients with increased IMT(>0.72).

Conclusion: In patients with RA, IR was significantly higher than that of healthy controls. A significant positive correlation was found between IR with both disease activity and disease duration in RA patients. Our study pointed out a significant association between IR and subclinical atherosclerosis in RA.

Disclosure:

A. M. Elsayed,
None;

S. A. El Bakry,
None;

S. A. M. Hassan,
None;

R. A. Rahman,
None;

R. A. Abo-Shady,
None;

N. Abaza,
None.

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