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Abstract
Objective
Rheumatoid arthritis (RA) is associated with an increased cardiovascular events. These may be related to insulin resistance (IR). We evaluated status of IR and analyzed the relationship between IR and clinical and laboratory characteristics in patients with RA.
Methods
We examined 52 RA patients (43 females) and 52 age and sex matched healthy controls. We measured Homeostasis model assessment (HOMA) IR, calculated according to fasting serum glucose and insulin.
Results
In patients, age was 50.8±10.2 years old, disease duration was 42.1±30.9 months. In controls, HOMA IR was 0.62±0.30 and in patients, it was 1.28±0.50. This difference was highly significant (p＜0.001). Patients with early RA (disease duration is less than 36 months) were 28, and established RA (more than 36 months) were 24. HOMA IR was significantly higher in patients with established RA (1.42±0.45) than those with early RA (1.16±0.45) (p=0.03), and significantly correlated with disease duration (r=0.36, p=0.01), BMI (r=0.36, p＜0.001), total cumulative prednisolon dose (r=0.34, p=0.01). Disease duration and BMI were independent predictors for HOMA IR (p＜0.01, p=0.03).
References
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Table 1.
Clinical characteristics of patients with RA and controls
SD: standard deviation, N: number, BMI: body mass index, BP: blood pressure, WC: waist circumference, TC: total cholesterol, HDL-C: high density lipoprotein, LDL-C: low density lipoprotein, HOMA IR: homeostasis model assessment of insulin resistance, CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, RF: rheumatoid factor, NS: non-significant
Table 2.
Correlations of HOMA IR with variables
BMI: body mass index, BP: blood pressure, WC: waist circumference, TC: total cholesterol, HDL-C: high density lipoprotein-cholesterol, LDL-C: low density lipoprotein-cholesterol, RF: rheumatoid factor, HOMA IR: homeostasis model assessment of insulin resistance, CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, NS: non-significant
Table 3.
Clinical characteristics according to disease duration
| Control (n=52) | Early RA (n=28) | Established RA (n=24) | p-value∗ | |
|---|---|---|---|---|
| Age, year | 50.8±10.2 | 50.1±11.1 | 49.8±9.4 | NS |
| Age at diagnosis | – | 51.9±11.7 | 45.2±9.7 | NS† |
| Disease duration | – | 20.0±9.0 | 64.5±23.0 | ＜0.001† |
| BMI, kg/m2 | 22.0±2.6 | 23.0±3.1 | 23.1±2.2 | NS |
| WC, cm | 76.4±6.7 | 77.5±8.6 | 78.4±6.2 | NS |
| Systolic BP, mmHg | 120.5±10.5 | 123.5±6.9 | 122.9±8.2 | NS |
| Diastolic BP, mmHg | 78.1±10.2 | 82.1±7.8 | 80.0±6.3 | NS |
| Fasting insulin, μIU/mL | 3.0±1.2 | 5.6±2.1 | 6.8±2.3 | ＜0.001 |
| Fasting glucose, mg/dL | 84.1±6.5 | 84.0±7.9 | 85.2±9.3 | NS |
| TC, mg/dL | 189.5±36.5 | 184.2±34.5 | 191.2±46.0 | NS |
| HDL, mg/dL | 61.1±12.6 | 61.2±14.4 | 59.3±13.1 | NS |
| LDL, mg/dL | 120.9±35.6 | 111.3±27.8 | 140.8±32.5 | NS |
| Triglycerides, mg/dL | 87.7±39.8 | 107.7±53.7 | 146.1±56.1 | 0.03 |
| HOMA IR | 0.62±0.30 | 1.16±0.45 | 1.42±0.45 | ＜0.001 |
| RF, IU/mL | – | 109.6±217.5 | 83.3±86.1 | NS† |
| ESR, mm/hour | – | 38.9±30.0 | 37.8±26.1 | NS† |
| CRP, mg/dL | – | 0.8±1.6 | 0.7±1.2 | NS† |
| Mean 6 month prednisolon, mg | – | 3.4±2.5 | 4.3±2.4 | NS† |
| Total prednisolon dose, mg | – | 2,197.8±1,445.4 | 9,080.0±4,233.8 | ＜0.001† |
† Statistical significances were tested by independent t-test. RA: rheumatoid arthritis, BMI: body mass index, BP: blood pressure, TC: total cholesterol, HDL-C: high density lipoprotein-cholesterol, HOMA IR: homeostasis model assessment of insulin resistance, RF: rheumatoid factor, CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, NS: non-significant
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