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, 42 (6), 394-402

Incidence and Effect of Insulin Resistance on Progression of Atherosclerosis in Rheumatoid Arthritis Patients of Long Disease Duration

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Incidence and Effect of Insulin Resistance on Progression of Atherosclerosis in Rheumatoid Arthritis Patients of Long Disease Duration

Aharna Guin et al. Biomed J.

Abstract

Background: The continued atherosclerotic risk in rheumatoid arthritis (RA) has been inadequately explained by conventional factors. Chronic inflammation and endothelial activation seems responsible for developing insulin resistance (IR). The study was aimed to assess the role of inflammation and endothelial activation causing IR in long term RA patients leading to increased atherosclerotic risk.

Methods: Fifty (25 long-duration and 25 short-duration) RA patients and twenty-three healthy controls were recruited excluding potential confounding co-morbidities. Fasting insulin, proinflammatory cytokines, endothelial stress markers and adipokines were quantified by ELISA. Homeostasis Model Assessment (HOMA)-IR calculated using glucose and insulin values. Atherosclerotic indices were measured using ultrasound.

Results: Lipid profile was comparable among groups. Mean carotid intima media thickness (cIMT) was significantly higher in both RA groups (p = 0.0062) compared to controls. HOMA-IR was significantly higher in long-duration RA (p = 0.005); it showed significant associations with DAS 28 (p = 0.01) and hsCRP (p = 0.03) in this subset. Mean cIMT for short-duration RA (p = 0.02) and long-duration RA (p = 0.0006) respectively was also significantly associated with HOMA-IR. Pro-inflammatory markers like TNF-α, resistin and leptin were highest in long-duration RA, higher in short-duration RA when compared to control group respectively. HOMA-IR was significantly dependent on TNF-α (p = 0.008), resistin (p = 0.031), leptin (p = 0.0054). Mean cIMT showed association with all parameters mainly with TNF-α (p = 0.001), iNOS (p = 0.001), resistin (p = 0.008) and leptin (p = 0.04).

Conclusions: Persistent inflammation leads to altered adipokine secretion promoting IR in RA patients with long disease duration. Treatment with conventional disease modifying anti-rheumatic drugs (DMARDs) is incomplete to control chronic inflammation and limit progression of atherosclerosis.

Keywords: Atherosclerosis; Endothelial stress; Inflammation; Insulin resistance; Rheumatoid arthritis.

Figures

Fig. 1
Fig. 1
Simple linear regression analysis representing the association of HOMA-IR with different variables with ESR (A) hsCRP (B) disease duration (C) and DAS 28 (D) of the long duration RA (RA>5 yrs) patients; R2 = simple linear regression coefficient of determination; p < 0.05 is considered significant.
Fig. 2
Fig. 2
Simple linear regression analysis representing the association of cIMT with HOMA-IR of (A) short duration RA (RA<1yr) and that of (B) long duration RA (RA>5yrs) respectively; R2 = simple linear regression coefficient of determination; p < 0.05 is considered significant.

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References

    1. Bacon P.A., Stevens R.J., Carruthers D.M., Young S.P., Kitas G.D. Accelerated atherogenesis in autoimmune rheumatic diseases. Autoimmun Rev. 2002;6:338–347. - PubMed
    1. Hannawi S., Haluska B., Marwick T.H., Thomas R. Atherosclerotic disease is increased in recent-onset rheumatoid arthritis: a critical role for inflammation. Arthritis Res Ther. 2007;9:R116. - PMC - PubMed
    1. Adhikari M.C., Guin A., Chakraborty S., Sinhamahapatra P., Ghosh A. Subclinical atherosclerosis and endothelial dysfunction in patients with early rheumatoid arthritis as evidenced by measurement of carotid intima-media thickness and flow-mediated vasodilatation: an observational study. Semin Arthritis Rheum. 2012;41:669–675. - PubMed
    1. Roman M.J., Moeller E., Davis A., Paget S.A., Crow M.K., Lockshin M.D. Preclinical carotid atherosclerosis in patients with rheumatoid arthritis. Ann Intern Med. 2006;144:249–256. - PubMed
    1. Gonzalez-Juanatey C., Llorca J., Martin J., Gonzalez-Gay M.A. Carotid intima-media thickness predicts the development of cardiovascular events in patients with rheumatoid arthritis. Semin Arthritis Rheum. 2009;38:366–371. - PubMed

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