Objectives: This study aims to evaluate the presence and factors related to insulin resistance (IR) in untreated very early rheumatoid arthritis (RA) patients. Patients and methods: Between June 2020 and July 2021, a total of 90 RA patients (29 males, 61 females; mean age: 49.3±10.2 years; range 24 to 68 years) and 90 age-, sex- and body mass index (BMI)-matched controls (35 males, 55 females; mean age: 48.3±5.1 years; range 38 to 62 years) were included. Homeostatic model assessment was applied to evaluate IR (HOMA-IR) and β-cell function (HOMA-β). Disease activity score 28 (DAS28) was used to estimate disease activity. Lipid profile, hemoglobin A1c (HbA1c), glucose, insulin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were measured. Logistic regression analysis was performed to investigate the relationship between the IR and clinical features of RA patients. Results: The RA patients had higher HOMA-IR values (p<0.001) and adverse lipid profile. The IR was positively correlated with age (r=0.35, p<0.01), CRP (r=0.42, p<0.001), ESR (r=0.33, p<0.01), disease duration (r=0.28, p<0.01), and DAS28 (r=0.50, p<0.001). The DAS28, CRP and age, but not sex and menopausal status, were independently associated with IR. Conclusion: Insulin resistance was present in untreated very early RA patients. The DAS28, CRP, and age were independent predictors for the presence of IR. Based on these findings, RA patients should be evaluated early for the presence of IR to reduce the risk of metabolic diseases.

Objective: To explore the effect of low dose prednisone treatment during pregnancy on blood glucose levels in patients with spontaneous abortion. Methods: In this single-center, prospective cohort study, patients with a history of spontaneous abortion were enrolled and were assigned to two groups according to whether they were exposed to low dose prednisone during pregnancy. All patients received oral glucose tolerance test (OGTT) at early pregnancy (before 12th week) and late pregnancy (24-28th week). Fasting serum C-peptide and plasma glycosylated hemoglobin (HbA1c) levels were measured at the same time. We compared the results of OGTT, fasting serum C-peptide levels and HbA1c levels between the two groups and analyzed the incidence of diabetes mellitus (DM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in early pregnancy and the incidence of gestational diabetes mellitus (GDM) in late pregnancy. Result: A total of 355 patients were enrolled and analyzed. No significant difference in OGTT between the two groups were observed in the first trimester (P=0.142). However, patients in the prednisone group showed a significant increase in fasting serum C-peptide (P<0.001). Regarding late pregnancy, although there was no significant difference in OGTT between the two groups (P=0.070), patients in the prednisone group showed a significant increase in 2-h plasma glucose (P=0.010). Patients in the prednisone group also had a higher incidence of GDM compared with the control group (P=0.005). Furthermore, family history of DM and receiving low dose prednisone were significantly associated with higher risk of gestational glycometabolism abnormality and receiving HCQ reduced the risk of that in patients with spontaneous abortion. Conclusion: Long-term exposure of low dose prednisone during pregnancy could impair postprandial blood glucose and increase the incidence of GDM. Routine monitor of blood glucose and C-peptide levels should be recommended in patients who received prednisone treatment during pregnancy. Family history of DM and exposure to low dose prednisone are both independent risk factors for gestational glycometabolism abnormality while receiving HCQ is a protective one in patients with spontaneous abortion. Trial registration Chinese Clinical Trials Registration: ChiCTR2100046455 (16/05/2021).