Objectives Rheumatoid Arthritis (RA) patients show alterations in cholesterol and lypoproteins levels. These disturbances seem to be related to the inflammation that takes place in the disease, but the pathological mechanisms that leed to it are unknown. Cholesterol ester transfer protein (CETP) is an enzyme that allows transference of cholesterol ester from HDL to LDL-cholesterol particles. CETP has recently gained interest as therapeutic goal of new treatments developed to treat dyslipidemia. The aim of this study is to describe the role of this enzyme in a model of chronic inflammation associated dyslipidemia as it occurs in rheumatoid arthritis. Methods 101 RA patients and 115 sex and age-matched controls were included. Serum levels of CEPT were measured by an enzimelinked inmunoassay and the enzymatic activity by a specific kit (Roar CEPT activity assay kit). In both patients and controls classical lipidic profile (cholesterol, triglycerides, HDL and LDL cholesterol, apolipoprotein A1, apolipoprotein B and lipoprotein A) was defined. Also ESR and CRP were determined. In RA patients disease activity indexes like DAS28 and HAQ were collected, as well as, sociodemographic variables, comorbidility and anthropometric variables. Multivariate analysis was performed to compare results between patients and controls adjusting for corticosteroids intake and for classical dyslipidemia risk factors. Results Serum protein levels were correlated with the enzimatic activity (r=0,5, p=0,00), showing that serum levels could be enough to express the activity of this enzime. Patients show lower CETP activity levels after adjusting for sex and age (beta coefficient -0,52 pmol/l, CI95% -0,87–0,18, p=0,01). In patients, CRP levels show a negative correlation with CETP activity (r=-0.34, p=0,03); in controls this correlation did not achieve the stadistic significance. Disease activity scores like DAS28 did not show association with CETP. Conclusions CETP is underexpressed in RA patients. Differencial characteristics of dyslipIdemia in RA could be partly explained by this fact. Disclosure of Interest None Declared
Objectives To explore the influence of body composition and abdominal adiposity on endothelial dysfunction and radiological damage in Rheumatoid Arthritis (RA) patients. Methods A total of 100 patients, 54 RA patients and 46 controls, adjusted for sex, body mass index (BMI), age and comorbidity, were included. Total body composition was measured by dual energy X-ray absorptiometry; total and regional lean mass, fat mass, fat free mass index (fat free mass/m2) and fat mass index (fat mass/m2) were established. Quantification of visceral and parietal abdominal fat area was determined using magnetic resonance imaging, as well as visceral/parietal fat index. Endothelial dysfunction was assessed by brachial artery flow-mediated dilatation (FMD) as the dilator response to 5 minutes distal cuff occlusion and after sublingual nitroglycerine administration, and the Sharp Score defined radiological damage. The 28-joint DAS (DAS-28) and disability using HAQ (Health Assessment Questionnaire) scores, erythrocyte sedimentation rate (ESR) and C-reactive protein were collected. Multivariate analysis was performed to compare body composition between controls and patients and the relationship between those and endothelial dysfunction and radiological damage, everything adjusted for demographic and comorbidity variables. Results In the univariate analysis RA patients showed less flow-mediated dilatation (5.9 vs 9.8 mm, p=0.03). Similarly, fat free mass index was higher in patients than in controls (beta coefficient 0,94 (CI95% 0,08-1,80), P=0,03) after adjusting for BMI, sex and age; on the other hand fat mass index tended to be higher in patients than in controls (beta coefficient 2,51 (CI95% -0,82-5,84), p=0.13). Parietal and visceral abdominal fat values did not show differences between controls and patients. Fat mass, lean mass and abdominal fat did not correlate with DAS-28, HAQ, ESR or CRP. Parietal abdominal fat through resonance imaging in RA patients showed a negative relation with flow-mediated dilatation (beta coefficient -0.045 mm FMD/cm2 parietal area, p=0.02) after adjusting for BMI. This relation was not found with visceral abdominal fat. Radiological damage was negatively correlated with total bone mass (beta coefficient -1,13, CI95% -2,05-0,22, p=0.02) and showed a negative trend to do it also with total lean mass (beta coefficient -1.11 CI95% 2,42-0,21, p=0,09). Conclusions Changes in body composition take place in RA patients. These changes can be related to the endothelial dysfunction and radiological damage that occurs in this disease. Disclosure of Interest None Declared
Objectives The retinol binding protein 4 (RBP4) has recently been described as a protein highly related with insulin resistance (IR) states like obesity and diabetes. The chronic inflammatory states, like in rheumatoid arthritis (RA), are linked also to insulin resistance by mechanisms that are unknown. Therefore, RA is considered as an insulin resistance model related with a chronic inflammatory state, where diabetes and obesity, classical factors for IR, are absent. The objective of this study is to estimate RBP4 expression in RA patients. Methods 101 RA patients and 115 age and sex-matched controls were included. Pancreatic beta cell function was estimated by classical insulinresistance indexes like HOMA (homeostatic model assessment 2). RBP4, C peptide and insuline levels were measured in patients and controls by a specific enzyme-linked immunosorbent assay (ELISA). Multivariate analysis was performed to compare results between patients and controls and the data were adjusted for glucocorticoids intake and for IR classical risk factors. Results RBP4 levels did not show differences between controls and patients, after adjusting for sex, age, body mass index (BMI) and waist circumference (lnRBP4 2,83 mcg/dl in patients vs. 2,70 mcg/dl, p=0,33). On going steroids patients showed higher RBP4 levels (lnRBP4 3,03 vs 2,61 mcg/dl, p=0.00), after adjusting for age, sex, BMI and waist circumference. Similarly, in the univariate analysis, RBP4 levels tended to correlate with steroid average dose (r=0,20, p=0,14). In our serie, RBP4 levels were not related with the classical IR characteristics, like abdominal waist and BMI, both in controls and patients. Nor these levels showed relation with ESR, CRP, insuline levels or disease activity indexes. Conclusions The molecular mechanisms that lead to IR in RA patients appear to be different from those that ocurr in obesity and diabetes status. RBP4 does not seem to play a role in IR in patients with RA. Disclosure of Interest None Declared
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