Session Information
Date: Tuesday, November 10, 2015
Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics Poster III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Growing evidence supports the view that systemic sclerosis (SSc) is a vascular disease mediated by autoimmunity and evolving into progressive tissue fibrosis. Several vascular biomarkers have been studied, but little is known about the role of metabolic derangement in vasculopathy in SSc. Our study aimed to investigate the relationship between insulin resistance and the digital ulcer (DU) in patients with SSc.
Methods: With a cross-sectional design, 69 female patients with SSc and 109 age-matched (± 2 years) female healthy subjects were consecutively recruited at a university-affiliated rheumatology center from June 2014 to May 2015. The magnitude of insulin resistance was evaluated by the homeostatic model assessment of insulin resistance (HOMA-IR) which was calculated as [fasting serum insulin (μIU/mL) × fasting serum glucose (mg/dL) / 405] and DU ever included active and healed ulcers. Skin fibrosis in SSc patients was assessed by modified Rodnan skin thickness score (MRSS).
Results: HOMA-IR in SSc patients was significantly higher than that in healthy subjects (1.09 (0.79-2.1) vs 0.72 (0.47-0.99), p<0.001). In SSc group, the mean age was 52.8 years, the median disease duration was 84 months and 33 patients (47.8%) had diffuse SSc. Nineteen patients (27.5%) had DU ever (6 active DU, 13 healed DU). SSc patients with DU ever had a significantly higher HOMA-IR (1.95 (1.22-2.8) vs 0.99 (0.71-1.75), p=0.002) and MRSS (15 (9-22) vs 9.5 (4.8-14), p=0.004) than those without DU ever. As shown in Table 1, in multivariable logistic regression analyses, increased log-transformed HOMA-IR showed a significant association with the presence of DU ever after adjustment of confounding factors such as MRSS (OR=2.42, 95% CI=1.01-5.8, p=0.047).
Conclusion: Increased insulin resistance was independently associated with the presence of digital ulcer in patients with SSc. Our data suggest that insulin resistance may contribute to the pathogenesis of vascular damage in SSc.
Table 1. Logistic regression models for the presence of digital ulcer in patients with systemic sclerosis
|
Variables |
Crude OR (95% CI) |
p |
Adjusted OR a (95% CI) |
p |
|
Log-transformed HOMA-IR |
2.96 (1.28-6.88) |
0.011 |
2.42 (1.01-5.8) |
0.047 |
|
MRSS |
1.13 (1.04-1.24) |
0.005 |
1.12 (1.02-1.22) |
0.018 |
|
ILD |
1.85 (0.96-3.53) |
0.064 |
|
|
|
Disease duration, months |
1.01 (0.99-1.01) |
0.097 |
|
|
|
Age, years |
0.96 (0.92-1.01) |
0.130 |
|
|
|
CRP, mg/dL |
0.78 (0.17-3.64) |
0.746 |
|
|
HOMA-IR; homeostatic model assessment of insulin resistance, MRSS; modified Rodnan skin thickness score, ILD; interstitial lung disease, CRP; C-reactive protein
a Estimated using multivariable logistic regression model with backward selection including log-transformed HOMA-IR, MRSS, ILD and disease duration.
To cite this abstract in AMA style:
Lee SG, Park EK, Koo DW, Kim GT, Tag HS, Lee JW. Insulin Resistance Is Associated with the Digital Ulcer in Patients with Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/insulin-resistance-is-associated-with-the-digital-ulcer-in-patients-with-systemic-sclerosis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/insulin-resistance-is-associated-with-the-digital-ulcer-in-patients-with-systemic-sclerosis/