THU0690 DISEASE ACTIVITY CORRELATES WITH INSULIN RESISTANCE AND ADIPOCYTOKINES IN PATIENTS WITH DMARD-NAÏVE RHEUMATOID ARTHRITIS

Abstract

Background Cardiovascular events such as myocardial infarction and stroke are frequent comorbidities in rheumatic diseases [1]. In relation, components of the metabolic syndrome (MS) including insulin resistance (IR), central obesity, high blood pressure, high triglycerides, and low high-density lipoprotein (HDL) are related to a high rate of endothelial dysfunction and atherosclerosis in patients with RA [2]. Objectives We aimed to investigate the relationship between disease activity and insulin resistance (IR) and the levels of adipocytokines in non-diabetic patients with newly diagnosed rheumatoid arthritis (RA) who are naive to disease modifying anti-rheumatic drugs (DMARDs). Methods Forty-seven DMARD-naive patients with RA and 25 age-, gender-, and BMI-matched controls were included. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), 28-joint-count disease activity score (DAS28), serum lipids, glucose, HbA1c, insulin, leptin, resistin, visfatin, and RBP4 levels were measured. Homeostasis model assessment for insulin resistance (HOMA-IR) was calculated. Patients were studied before and 3 months after treatment with DMARDs. Results Levels of adipokines were similar in patients with RA and controls (p > 0.05 for all). However, RA patients with active disease (DAS28 > 3.2) had numerically higher levels of leptin (9.3 (3.7-17.4) vs. 7.6 (3.7-11.0), p = 0.289), insulin (8.0 (5.2-12.7) vs. 5.9 (4.2-8.7), p = 0.285), and HOMA-IR (1.9 (1.1-3.0) vs. 1.3 (1.0-1.9), p = 0.209). DAS28 was correlated with HOMA-IR (r = 0.356, p = 0.016), insulin (r = 0.323, p = 0.02), and leptin (r = 0.399, p = 0.005) in the study group (Figure-1). Regardless of the type of treatment modality, leptin levels (7.4 (4.4-13.4) vs. 6.4 (3.3-11.6, p = 0.047) decreased significantly after treatment, as did insulin levels (6.9 (4.9-12.5) vs. 5.9 (4.1- 8.8), p =0.01) and HOMA-IR score (1.7 (1.1-2.7) vs. 1.3 (1.0-2.0), p= 0.012). The reduction in leptin was more prominent in patients with active disease (9.3 (3.7-17.4) vs. 6.9 (3.1-11.4), p = 0.028). The reduction in ESR was correlated with ΔHOMA-IR (r = 0.308, p = 0.039), and CRP reduction was correlated with Δresistin (r = 0.288, p = 0.049) and ΔRBP4 (r = 0.456, p = 0.001). Conclusion Disease activity is associated with IR and correlates with circulating levels of adipokines in patients with RA. Treatment with DMARDs reduces leptin and improves IR.