University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania 15261, USA.
Arthritis Care Res (Hoboken). 2011 Apr;63(4):512-21. doi: 10.1002/acr.20414.
To perform a systematic literature review of the potential association among molecular markers of inflammation, alterations in body composition, and insulin resistance (IR), a precursor to type 2 diabetes mellitus (DM), in rheumatoid arthritis (RA) patients. To determine the impact of tumor necrosis factor α (TNFα) as a pivotal proinflammatory cytokine in the pathophysiology of type 2 DM and RA, and the effect of antirheumatic drugs on glycemic control.
We performed a search of PubMed to identify articles on IR and body habitus in patients with RA.
Patients with RA had characteristics placing them at high risk for IR and type 2 DM. The incidence and prevalence of type 2 DM in RA was not clearly increased compared with the general population; however, studies suggested that patients with RA are likely to have IR and have increased risk of cardiovascular disease (CVD). The prevalence of type 2 DM and IR could be estimated from reports of risk factors for CVD in RA patients. The TNFα antagonists provided rapid and effective control of RA-related inflammation. Evidence indicated that extended use of TNFα antagonists in RA may provide the additional benefit of improving insulin sensitivity. These treatment-related changes may contribute to an overall reduction in the risk of type 2 DM and CVD in RA patients.
Controlling inflammation may improve insulin sensitivity and subsequently reduce the risk of developing type 2 DM in RA patients. This may also reduce the risk of CVD in this high-risk group. Future studies are required to elucidate the relationships between inflammation, body composition, IR, TNFα antagonist use, and the risk of developing type 2 DM in RA patients.
对炎症分子标志物、身体成分改变与胰岛素抵抗（IR）之间的潜在关联进行系统文献回顾，IR 是 2 型糖尿病（DM）的前期表现，发生于类风湿关节炎（RA）患者中。目的在于确定肿瘤坏死因子α（TNFα）作为 2 型 DM 和 RA 病理生理学中的关键促炎细胞因子的作用，以及抗风湿药物对血糖控制的影响。
我们在 PubMed 上进行了检索，以确定有关 RA 患者 IR 和身体形态的文章。
RA 患者具有发生 IR 和 2 型 DM 的高危特征。与普通人群相比，RA 患者中 2 型 DM 的发病率和患病率并未明显增加；然而，研究表明，RA 患者可能存在 IR，并且发生心血管疾病（CVD）的风险增加。RA 患者 CVD 危险因素的报告可以估计 2 型 DM 和 IR 的患病率。TNFα 拮抗剂可快速有效地控制 RA 相关炎症。有证据表明，RA 患者长期使用 TNFα 拮抗剂可能具有改善胰岛素敏感性的额外益处。这些治疗相关的变化可能有助于降低 RA 患者 2 型 DM 和 CVD 的总体风险。
控制炎症可能会改善胰岛素敏感性，从而降低 RA 患者发生 2 型 DM 的风险。这也可能降低该高危人群发生 CVD 的风险。需要进一步的研究来阐明炎症、身体成分、IR、TNFα 拮抗剂的使用与 RA 患者发生 2 型 DM 的风险之间的关系。
