Cumulative inflammatory burden and obesity as determinants of insulin resistance in patients with established rheumatoid arthritis: cross-sectional study

Abstract

ObjectivesTo describe the prevalence of insulin resistance (IR) in patients with established rheumatoid arthritis (RA) and to analyse the contribution of cumulative inflammatory burden and other factors to its development.DesignObservational cross-sectional study.ParticipantsPatients with RA and controls matched for age, sex and Body Mass Index. We excluded patients with diabetes.SettingsPatients from an RA inception cohort at Hospital Regional Universitario de Málaga, Spain, were recruited between September 2016 and May 2018.Primary and secondary outcome measuresIR was evaluated using the homeostasis model assessment for IR and beta-cell function and the quantitative insulin sensitivity check index. Other variables included the cumulative 28-Joint Disease Activity Score (DAS28) with C reactive protein (CRP) body composition and cytokines. Two logistic regression models were constructed to identify factors associated with IR in patients with RA.ResultsEighty-nine patients with RA and 80 controls were included. The prevalence of IR was similar in both cases and controls. Inflammatory activity was controlled appropriately in patients during follow-up (mean DAS28 3.1 (0.8)). The presence of IR in patients with RA was associated with obesity (OR 6.01, 95% CI 1.9 to 8.7), higher cumulative DAS28-CRP values during follow-up (OR 2.8, 95% CI 1.3 to 6.0), and higher interleukin-1β levels (OR 1.6, 95% CI 1.1 to 2.4). The second model showed that the risk of IR increased by 10% for each kilogram of excess body fat.ConclusionIn patients with well-controlled, established RA, IR is associated mainly with poorer control of inflammation from diagnosis and with obesity, specifically total fat mass.

Sarcopenia and Nutrition in Elderly Rheumatoid Arthritis Patients: A Cross-Sectional Study to Determine Prevalence and Risk Factors

“…Specifically, sarcopenic obesity was recorded in 10% of the RA patients in the present study and was rare among the controls. These findings are consistent with those reported elsewhere [22], which highlight the major role of inflammation and fatty tissue in the pathogenesis of sarcopenia in RA: adipocytes undergo hypertrophy and hyperplasia and behave like an inflammatory tissue that produces excess levels of proinflammatory mediators, such as TNF-α, IL-12 and IL-6 [59,60], and leptin [16]. A chronically high concentration of proinflammatory cytokines over time promotes proteolysis, and together with low physical activity and poor nutritional status, increases the risk of sarcopenia and cardiovascular disease in affected patients [20,61,62].…”

Sex-Specific Association of Left Ventricular Hypertrophy With Rheumatoid Arthritis

“…In keeping with our observations, excessive body weight was associated with poor disease control and unfavorable CVD outcomes in RA patients ( 22 ). In patients with well-controlled, established RA, obesity, and total fat mass are also associated with more inadequate control of inflammation from diagnosis ( 23 ).…”

Adiposity Is Related to Inflammatory Disease Activity in Juvenile Idiopathic Arthritis

“…In adult chronic arthritis, such as rheumatoid arthritis and psoriatic arthritis, obesity and adiposity have a negative effect on disease control and response to therapy [49]. However, few studies have evaluated the association between adiposity and/or obesity and inflammatory activity in JIA.…”