[Endothelial dysfunction is associated with insulin resistance in patients with rheumatoid arthritis]. / Relación entre disfunción endotelial y resistencia a la insulina en pacientes con artritis reumatoide.

BACKGROUND AND OBJECTIVES: There is an increased incidence of cardiovascular disease in rheumatoid arthritis (RA). Endothelial dysfunction is an early step in atherogenesis that is related to insulin resistance (IR). Our objective was to determine the relationship between endothelial dysfunction and IR in RA patients. The presence of other cardiovascular risk factors (CVRF) and their relationship with endothelial dysfunction and inflammatory markers was also evaluated. PATIENTS AND METHOD: Twenty RA patients without cardiovascular disease were studied. CVRF, treatments, body mass index, abdominal perimeter, clinical disease activity (DAS28), erythrocyte sedimentation rate, reactive C protein, lipid profile, homocysteine and insulin resistance (QUICKI) were determined. Endothelial function was measured by laser-doppler. RESULTS: We observed a positive correlation between the QUICKI index and microvascular endothelial function. We did not observe any relationship between endothelial function and inflammatory or clinical activity. CONCLUSIONS: In our population, the presence of IR in AR patients is associated with the development of endothelial dysfunction rather than with the degree of inflammatory response.

Relación entre disfunción endotelial y resistencia a la insulina en pacientes con artritis reumatoide / Endothelial dysfunction is associated with insulin resistance in patients with rheumatoid arthritis

Fundamento y objetivo: En los pacientes con artritis reumatoide (AR) se observa un aumento de la incidencia de enfermedad cardiovascular. La disfunción endotelial es una alteración precoz en la aterogénesis, relacionada con la resistencia a la insulina (RI). El objetivo de este trabajo ha sido determinar la relación entre la disfunción endotelial y la RI en personas con AR. Se estudió la presencia de otros factores de riesgo cardiovascular y su relación con la función endotelial y marcadores de inflamación/actividad de la enfermedad. Pacientes y método: En 20 pacientes con AR sin enfermedad cardiovascular analizamos los antecedentes de factores de riesgo cardiovascular, medicación, índice de masa corporal, perímetro abdominal, actividad clínica de la enfermedad (mediante la escala DAS-28), velocidad de sedimentación globular, proteína C reactiva, perfil lipídico, homocisteína y RI (mediante el índice QUICKI: Quantitive Insulin Sensivity Check Index). La función endotelial se midió mediante fluometría láser-Doppler. Resultados: Se observó una relación positiva entre el QUICKI y la variación en el flujo capilar de la piel. No se encontró relación entre la función endotelial y la actividad clínica o biológica. Conclusiones: Nuestros datos indican que la RI podría ser un nexo entre la AR y la disfunción endotelial, por lo que se precisaría realizar estudios más extensos y con métodos más sensibles

Background and objectives: There is an increased incidence of cardiovascular disease in rheumatoid arthritis (RA). Endothelial dysfunction is an early step in atherogenesis that is related to insulin resistance (IR). Our objective was to determine the relationship between endothelial dysfunction and IR in RA patients. The presence of other cardiovascular risk factors (CVRF) and their relationship with endothelial dysfunction and inflammatory markers was also evaluated. Patients and method: Twenty RA patients without cardiovascular disease were studied. CVRF, treatments, body mass index, abdominal perimeter, clinical disease activity (DAS28), erythrocyte sedimentation rate, reactive C protein, lipid profile, homocisteine and insulin resistance (QUICKI) were determined. Endothelial function was measured by laser-doppler. Results: We observed a positive correlation between the QUICKI index and microvascular endothelial function. We did not observe any relationship between endothelial function and inflammatory or clinical activity. Conclusions: In our population, the presence of IR in AR patients is associated with the development of endothelial dysfunction rather than with the degree of inflammatory response