Ye Lu, Zhang Xin, Wu Huaxiang, Chen Yahui, Zhou Haibo, Wang Qiaohong, Xu Weihong
Department of Rheumatology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
Department of Gastroenterology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
Arch Rheumatol. 2022 Jun 6;37(4):593-602. doi: 10.46497/ArchRheumatol.2022.9117. eCollection 2022 Dec.
This study aims to evaluate the presence and factors related to insulin resistance (IR) in untreated very early rheumatoid arthritis (RA) patients.
Between June 2020 and July 2021, a total of 90 RA patients (29 males, 61 females; mean age: 49.3±10.2 years; range 24 to 68 years) and 90 age-, sex- and body mass index (BMI)-matched controls (35 males, 55 females; mean age: 48.3±5.1 years; range 38 to 62 years) were included. Homeostatic model assessment was applied to evaluate IR (HOMA-IR) and β-cell function (HOMA-β). Disease activity score 28 (DAS28) was used to estimate disease activity. Lipid profile, hemoglobin A1c (HbA1c), glucose, insulin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were measured. Logistic regression analysis was performed to investigate the relationship between the IR and clinical features of RA patients.
The RA patients had higher HOMA-IR values (p<0.001) and adverse lipid profile. The IR was positively correlated with age (r=0.35, p<0.01), CRP (r=0.42, p<0.001), ESR (r=0.33, p<0.01), disease duration (r=0.28, p<0.01), and DAS28 (r=0.50, p<0.001). The DAS28, CRP and age, but not sex and menopausal status, were independently associated with IR.
Insulin resistance was present in untreated very early RA patients. The DAS28, CRP, and age were independent predictors for the presence of IR. Based on these findings, RA patients should be evaluated early for the presence of IR to reduce the risk of metabolic diseases.
本研究旨在评估未经治疗的极早期类风湿关节炎（RA）患者胰岛素抵抗（IR）的存在情况及相关因素。
在2020年6月至2021年7月期间，共纳入90例RA患者（男性29例，女性61例；平均年龄：49.3±10.2岁；年龄范围24至68岁）以及90例年龄、性别和体重指数（BMI）匹配的对照者（男性35例，女性55例；平均年龄：48.3±5.1岁；年龄范围38至62岁）。采用稳态模型评估法评估IR（HOMA-IR）和β细胞功能（HOMA-β）。使用疾病活动度评分28（DAS28）来评估疾病活动度。检测血脂谱、糖化血红蛋白（HbA1c）、血糖、胰岛素、C反应蛋白（CRP）和红细胞沉降率（ESR）。进行逻辑回归分析以研究RA患者IR与临床特征之间的关系。
RA患者的HOMA-IR值较高（p<0.001）且血脂谱不良。IR与年龄（r=0.35，p<0.01）、CRP（r=0.42，p<0.001）、ESR（r=0.33，p<0.01）、病程（r=0.28，p<0.01）和DAS28（r=0.50，p<0.001）呈正相关。DAS28、CRP和年龄与IR独立相关，而性别和绝经状态与IR无关。
未经治疗的极早期RA患者存在胰岛素抵抗。DAS28、CRP和年龄是IR存在的独立预测因素。基于这些发现，应尽早对RA患者进行IR评估，以降低代谢性疾病的风险。
