Insulin resistance and impaired beta cell function in rheumatoid arthritis.

Full Abstract

OBJECTIVE:
To identify factors that regulate glucose metabolism in rheumatoid arthritis (RA).

METHODS:
We evaluated the homeostatic model assessment of insulin resistance (HOMA-IR) and beta cell function (HOMA-B) in 94 RA patients. We investigated the relationship between characteristics known to affect glucose metabolism in the general population (age, abdominal obesity [waist circumference], hypertension, antihypertensive therapy) as well as characteristics of RA (disease activity, glucocorticoid therapy) and insulin resistance and beta cell function.

RESULTS:
Patients with high-grade inflammation (high-sensitivity C-reactive protein value >1.92 mg/liter) (n = 81) were more insulin resistant than patients with low-grade inflammation (n = 13), whereas beta cell function was similar in both groups. Insulin resistance and beta cell function were similar in both groups after adjustment for waist circumference. All recorded characteristics except for age were associated with HOMA-IR or/and HOMA-B in univariate analyses. In mixed regression models, abdominal obesity and patient's assessment of disease activity (by visual analog scale) were predictors of insulin resistance. The Disease Activity Score assessed using 28-joint counts for swelling and tenderness, tender joint count, and patient's assessment of disease activity were associated with reduced beta cell function, and the cumulative dose of glucocorticoids was associated with enhanced beta cell function. The cumulative glucocorticoid dose in all study patients was a mean of only 536 mg (95% confidence interval 239-1,173). In patients with high-grade inflammation, age was further associated with impaired beta cell function, whereas use of angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers was associated with enhanced beta cell function.

CONCLUSION:
The modifiable factors of abdominal obesity, antihypertensive therapy, disease activity, and use of glucocorticoids appear to affect glucose metabolism in RA.

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Author information

Author/s: Dessein, Patrick H (PH); Joffe, Barry I (BI);

Affiliation: Johannesburg Hospital and Milpark Hospital, University of the Witwatersrand, Johannesburg, South Africa. Dessein(-atsign-)telkomsa.net

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Arthritis and rheumatism (Arthritis Rheum), published in United States. (Language: eng)

Reference: 2006-Sep; vol 54 (issue 9) : pp 2765-75

Dates: Created 2006/10/02; Completed 2006/11/08; Revised 2006/11/15;

PMID: 16947779, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Arthritis, Rheumatoid - physiopathology
Blood Glucose - metabolism
Blood Pressure
Body Mass Index
Body Size
C-Reactive Protein - analysis
Diabetes Mellitus - epidemiology
Female
Homeostasis

Homeostasis
Humans
Inflammation - blood; physiopathology
Insulin Resistance - physiology
Islets of Langerhans - physiopathology
Male
Middle Aged
Models, Biological
Obesity - physiopathology

Associated Chemicals: Blood Glucose (0) ; C-Reactive Protein (9007-41-4)

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