A Study of Insulin Resistance in Rheumatoid Arthritis

ABSTRACT

Introduction: Chronic activation of the immune system,as observed in the pathogenesis of rheumatoid arthritis,potentially leads to insulin resistance. Insulin resistance is amajor component of type 2 diabetes mellitus and metabolicsyndrome. The risk of myocardial infarction is more thantwice in rheumatoid arthritis cases compared to the generalpopulation. Stratifying those at risk could direct therapies forprevention of significant morbidity and mortality.Material and methods: This is a case-control study of 102cases of Rheumatoid Arthritis diagnosed by ACR/EULAR2010 and a similar number of age and sex-matched healthycontrols. Insulin resistance was calculated using HOMA-IRmodel, those having values greater than 2.5 were consideredinsulin resistant. HOMA-IR values were correlated to diseaseactivity (using the DAS28 score). Blood pressure, BMI, waisthip ratio and lipid profile were compared between the twogroups.Results: 71.6% Rheumatoid Arthritis cases were insulinresistant whereas the same in controls was 21.4%, althoughthe mean BMI was lower in the former (22.78±2.71 vs23.21±3.20). Insulin resistance was more prevalent (69.8%) inthose with high disease activity (DAS28>5.1). Blood pressurewas lower in the control group but the lipid profile was betterin the cases.Conclusion: This study showed that the majority of patientsand 1/5th of the apparently healthy population had insulinresistance. There was significant correlation betweendisease activity and insulin resistance. All those havinginsulin resistance need to be carefully monitored to preventcardiovascular morbidity and mortality