Dessein Patrick H, Joffe Barry I, Stanwix Anne, Botha Andre S, Moomal Zubair
Department of Rheumatology, University of Witwatersrand, Johannesburg, South Africa.
J Rheumatol. 2002 Mar;29(3):462-6.
Rheumatoid arthritis (RA) is associated with an increased mortality rate from cardiovascular disease. This may relate to insulin resistance and dyslipidemia, which were both reported to correlate with the acute phase response in RA. We investigated whether insulin resistance and dyslipidemia could be explained by the acute phase response as well as excess weight in inflammatory arthritis.
We investigated 87 patients, 38 with RA, 29 with spondyloarthropathy, 20 with undifferentiated inflammatory arthritis. Thirty age, sex, and race matched healthy volunteers served as controls. Fasting blood samples were taken for determination of erythrocyte sedimentation rate (ESR), plasma glucose, serum insulin, and total cholesterol (chol), low density lipoprotein cholesterol (LDL-chol), high density lipoprotein cholesterol (HDL-chol), and triglycerides. Insulin resistance was estimated by the homeostasis model assessment for insulin resistance (HOMA) and the quantitative insulin sensitivity check index (QUICKI).
In controls the mean (SD) HOMA (microU x mmol/ml x l), QUICKI, body mass index (BMI, kg/m2), and ESR (mm/h) were 1.1 (0.5), 0.393 (0.048), 22.9 (2.8), and 13 (8) in patients; they were 1.9 (1.3), 0.357 (0.037), 26.5 (4.2), and 26 (18) in controls, respectively. Each of these differences was highly significant (p < 0.001). HDL-chol concentrations were lower (p = 0.002) and chol/HDL-chol ratios and triglyceride levels were higher (p < 0.001 and p = 0.004, respectively) in patients compared to controls. A high ESR predicted insulin resistance and dyslipidemia, while a high BMI similarly predicted insulin resistance but not dyslipidemia. After controlling for ESR and BMI, insulin sensitivity was no longer different between patients and controls, while HDL-chol concentrations remained lower (p = 0.015) and chol/HDL-chol ratios remained higher (p = 0.003) in patients compared to controls.
Insulin resistance and dyslipidemia were highly prevalent in patients with inflammatory arthritis. The acute phase response and excess weight could fully explain the insulin resistance but only partially explain the dyslipidemia. These findings have important implications for the management of inflammatory arthritis.
类风湿关节炎（RA）与心血管疾病死亡率升高相关。这可能与胰岛素抵抗和血脂异常有关，据报道二者均与RA的急性期反应相关。我们研究了胰岛素抵抗和血脂异常是否可由急性期反应以及炎症性关节炎中的超重现象来解释。
我们调查了87例患者，其中38例患有RA，29例患有脊柱关节炎，20例患有未分化的炎症性关节炎。30名年龄、性别和种族匹配的健康志愿者作为对照。采集空腹血样以测定红细胞沉降率（ESR）、血浆葡萄糖、血清胰岛素以及总胆固醇（chol）、低密度脂蛋白胆固醇（LDL-chol）、高密度脂蛋白胆固醇（HDL-chol）和甘油三酯。通过胰岛素抵抗稳态模型评估（HOMA）和定量胰岛素敏感性检查指数（QUICKI）来评估胰岛素抵抗。
患者组的平均（标准差）HOMA（微单位×毫摩尔/毫升×升）、QUICKI、体重指数（BMI，千克/平方米）和ESR（毫米/小时）分别为1.1（0.5）、0.393（0.048）、22.9（2.8）和13（8）；对照组分别为1.9（1.3）、0.357（0.037）、26.5（4.2）和26（18）。这些差异均具有高度显著性（p < 0.001）。与对照组相比，患者组的HDL-chol浓度较低（p = 0.002），chol/HDL-chol比值和甘油三酯水平较高（分别为p < 0.001和p = 0.004）。高ESR预示着胰岛素抵抗和血脂异常，而高BMI同样预示着胰岛素抵抗，但不能预示血脂异常。在控制ESR和BMI后，患者组与对照组之间的胰岛素敏感性不再有差异，但与对照组相比，患者组的HDL-chol浓度仍然较低（p = 0.015），chol/HDL-chol比值仍然较高（p = 0.003）。
胰岛素抵抗和血脂异常在炎症性关节炎患者中非常普遍。急性期反应和超重可充分解释胰岛素抵抗，但只能部分解释血脂异常。这些发现对炎症性关节炎的管理具有重要意义。
