Dataset Information

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

ABSTRACT:

Objectives

To 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.

Design

Observational cross-sectional study.

Participants

Patients with RA and controls matched for age, sex and Body Mass Index. We excluded patients with diabetes.

Settings

Patients from an RA inception cohort at Hospital Regional Universitario de Málaga, Spain, were recruited between September 2016 and May 2018.

Primary and secondary outcome measures

IR 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.

Results

Eighty-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-1? 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.

Conclusion

In patients with well-controlled, established RA, IR is associated mainly with poorer control of inflammation from diagnosis and with obesity, specifically total fat mass.

SUBMITTER: Manrique-Arija S

PROVIDER: S-EPMC7875272 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

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

Manrique-Arija Sara S Mena-Vazquez Natalia N Ureña Inmaculada I Rioja José J Valdivielso Pedro P Ginel-Mendoza Leovigildo L Abad-Sánchez Salomé S Jiménez-Núñez Francisco G FG Oliver-Martos Begoña B Fernandez-Nebro Antonio A

BMJ open 20210209 2

<h4>Objectives</h4>To 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.<h4>Design</h4>Observational cross-sectional study.<h4>Participants</h4>Patients with RA and controls matched for age, sex and Body Mass Index. We excluded patients with diabetes.<h4>Settings</h4>Patients from an RA inception cohort at Hospital Regional Universitario d ...[more]

PMID: 33563625

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Project description:IntroductionDespite the widespread use of magnetic resonance imaging (MRI) and Doppler ultrasound for the detection of rheumatoid arthritis (RA) disease activity, little is known regarding the association of imaging-detected activity and synovial pathology. The purpose of this study was to compare site-specific release of inflammatory mediators and evaluate the corresponding anatomical sites by examining colour Doppler ultrasound (CDUS) and MRI scans.MethodsRA patients were evaluated on the basis of CDUS and 3-T MRI scans and subsequently underwent synovectomy using a needle arthroscopic procedure of the hand joints. The synovial tissue specimens were incubated for 72 hours, and spontaneous release of monocyte chemoattractant protein 1 (MCP-1), interleukin 6 (IL-6), macrophage inflammatory protein 1? (MIP-1?) and IL-8 was measured by performing multiplex immunoassays. Bone marrow oedema (BME), synovitis and erosion scores were estimated on the basis of the rheumatoid arthritis magnetic resonance imaging score (RAMRIS). Mixed models were used for the statistical analyses. Parsimony was achieved by omitting covariates with P > 0.1 from the statistical model.ResultsTissue samples from 58 synovial sites were obtained from 25 patients. MCP-1 was associated with CDUS activity (P = 0.009, approximate Spearman's ? = 0.41), RAMRIS BME score (P = 0.01, approximate Spearman's ? = 0.42) and RAMRIS erosion score (P = 0.03, approximate Spearman's ? = 0.31). IL-6 was associated with RAMRIS synovitis score (P = 0.04, approximate Spearman's ? = 0.50), BME score (P = 0.04, approximate Spearman's ? = 0.31) and RAMRIS erosion score (P = 0.03, approximate Spearman's ? = 0.35). MIP-1? was associated with CDUS activity (P = 0.02, approximate Spearman's ? = 0.38) and RAMRIS synovitis scores (P = 0.02, approximate Spearman's ? = 0.63). IL-8 associations with imaging outcome measures did not reach statistical significance.ConclusionsThe association between imaging activity and synovial inflammatory mediators underscores the high sensitivity of CDUS and MRI in the evaluation of RA disease activity. The associations found in our present study have different implications for synovial mediator releases and corresponding imaging signs. For example, MCP-1 and IL-6 were associated with both general inflammation and bone destruction, in contrast to MIP-1?, which was involved solely in general synovitis. The lack of association of IL-8 with synovitis was likely underestimated because of a large proportion of samples above assay detection limits among the patients with the highest synovitis scores.

Dataset Information

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

Objectives

Design

Participants

Settings

Primary and secondary outcome measures

Results

Conclusion

Publications

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

Similar Datasets

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