Insulin resistance in rheumatoid arthritis

Disease-related indicators and associations with the presence and progression of subclinical atherosclerosis

Jon T. Giles, Stamatina Danielides, Moyses Szklo, Wendy S Post, Roger S Blumenthal, Michelle Petri, Pamela J. Schreiner, Matthew Budoff, Robert Detrano, Joan M. Bathon

Research output: Contribution to journalArticle

Abstract

Objective Systemic inflammation and insulin resistance (IR) are linked, yet the determinants of IR and its impact on atherosclerosis in rheumatoid arthritis (RA) are incompletely understood. The aim of this study was to explore the prevalence of IR in RA and non-RA populations and investigate whether the associations of IR with measures of atherosclerosis differ between these groups. Methods IR was quantified using the homeostatic model assessment of IR (HOMA-IR), and was compared between RA patients and demographically matched non-RA controls. Differences in the associations between the HOMA-IR index and the Agatston coronary artery calcium (CAC) score, ultrasound-determined intima-media thickness (IMT) of the common carotid artery (CCA) and internal carotid artery (ICA), and focal plaque in the ICA/carotid bulb were compared according to RA status. Results Among the 195 RA patients and 198 controls studied, average HOMA-IR levels were higher in the RA group by 31%, and were consistently higher in the RA group regardless of stratification by demographic or cardiometabolic risk factors. While the HOMA-IR index was strongly and significantly associated with C-reactive protein (CRP) and interleukin-6 (IL-6) levels in the control group, the association was weaker in the RA group. Among RA patients, higher HOMA-IR levels were associated with rheumatoid factor (RF) seropositivity in men and women, and prednisone use in women only. Before adjustment, higher HOMA-IR levels were associated with all assessed measures of subclinical atherosclerosis in the control group only; associations were diminished and lost statistical significance after adjustment for cardiovascular risk factors. Among the RA patients, neither baseline nor average HOMA-IR levels were significantly associated with change in any of the atherosclerosis measures over an average of 3.2 years of followup. Conclusion Although IR was higher in RA patients than in non-RA controls, higher levels may not independently impart additional risk of atherosclerosis.

Original languageEnglish (US)
Pages (from-to)626-636
Number of pages11
JournalArthritis and Rheumatology
Volume67
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Insulin Resistance
Rheumatoid Arthritis
Atherosclerosis
Arthritis
Internal Carotid Artery
Control Groups
Rheumatoid Factor
Carotid Stenosis
Common Carotid Artery
Prednisone
C-Reactive Protein
Interleukin-6
Coronary Vessels
Demography
Inflammation
Calcium

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy
  • Rheumatology
  • Medicine(all)

Cite this

Insulin resistance in rheumatoid arthritis : Disease-related indicators and associations with the presence and progression of subclinical atherosclerosis. / Giles, Jon T.; Danielides, Stamatina; Szklo, Moyses; Post, Wendy S; Blumenthal, Roger S; Petri, Michelle; Schreiner, Pamela J.; Budoff, Matthew; Detrano, Robert; Bathon, Joan M.

In: Arthritis and Rheumatology, Vol. 67, No. 3, 01.03.2015, p. 626-636.

Research output: Contribution to journalArticle

@article{6e8d40d953d14e028a4a9b7d88486959,
title = "Insulin resistance in rheumatoid arthritis: Disease-related indicators and associations with the presence and progression of subclinical atherosclerosis",
abstract = "Objective Systemic inflammation and insulin resistance (IR) are linked, yet the determinants of IR and its impact on atherosclerosis in rheumatoid arthritis (RA) are incompletely understood. The aim of this study was to explore the prevalence of IR in RA and non-RA populations and investigate whether the associations of IR with measures of atherosclerosis differ between these groups. Methods IR was quantified using the homeostatic model assessment of IR (HOMA-IR), and was compared between RA patients and demographically matched non-RA controls. Differences in the associations between the HOMA-IR index and the Agatston coronary artery calcium (CAC) score, ultrasound-determined intima-media thickness (IMT) of the common carotid artery (CCA) and internal carotid artery (ICA), and focal plaque in the ICA/carotid bulb were compared according to RA status. Results Among the 195 RA patients and 198 controls studied, average HOMA-IR levels were higher in the RA group by 31{\%}, and were consistently higher in the RA group regardless of stratification by demographic or cardiometabolic risk factors. While the HOMA-IR index was strongly and significantly associated with C-reactive protein (CRP) and interleukin-6 (IL-6) levels in the control group, the association was weaker in the RA group. Among RA patients, higher HOMA-IR levels were associated with rheumatoid factor (RF) seropositivity in men and women, and prednisone use in women only. Before adjustment, higher HOMA-IR levels were associated with all assessed measures of subclinical atherosclerosis in the control group only; associations were diminished and lost statistical significance after adjustment for cardiovascular risk factors. Among the RA patients, neither baseline nor average HOMA-IR levels were significantly associated with change in any of the atherosclerosis measures over an average of 3.2 years of followup. Conclusion Although IR was higher in RA patients than in non-RA controls, higher levels may not independently impart additional risk of atherosclerosis.",
author = "Giles, {Jon T.} and Stamatina Danielides and Moyses Szklo and Post, {Wendy S} and Blumenthal, {Roger S} and Michelle Petri and Schreiner, {Pamela J.} and Matthew Budoff and Robert Detrano and Bathon, {Joan M.}",
year = "2015",
month = "3",
day = "1",
doi = "10.1002/art.38986",
language = "English (US)",
volume = "67",
pages = "626--636",
journal = "Arthritis and Rheumatology",
issn = "2326-5191",
publisher = "John Wiley and Sons Ltd",
number = "3",

}

TY - JOUR

T1 - Insulin resistance in rheumatoid arthritis

T2 - Disease-related indicators and associations with the presence and progression of subclinical atherosclerosis

AU - Giles, Jon T.

AU - Danielides, Stamatina

AU - Szklo, Moyses

AU - Post, Wendy S

AU - Blumenthal, Roger S

AU - Petri, Michelle

AU - Schreiner, Pamela J.

AU - Budoff, Matthew

AU - Detrano, Robert

AU - Bathon, Joan M.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Objective Systemic inflammation and insulin resistance (IR) are linked, yet the determinants of IR and its impact on atherosclerosis in rheumatoid arthritis (RA) are incompletely understood. The aim of this study was to explore the prevalence of IR in RA and non-RA populations and investigate whether the associations of IR with measures of atherosclerosis differ between these groups. Methods IR was quantified using the homeostatic model assessment of IR (HOMA-IR), and was compared between RA patients and demographically matched non-RA controls. Differences in the associations between the HOMA-IR index and the Agatston coronary artery calcium (CAC) score, ultrasound-determined intima-media thickness (IMT) of the common carotid artery (CCA) and internal carotid artery (ICA), and focal plaque in the ICA/carotid bulb were compared according to RA status. Results Among the 195 RA patients and 198 controls studied, average HOMA-IR levels were higher in the RA group by 31%, and were consistently higher in the RA group regardless of stratification by demographic or cardiometabolic risk factors. While the HOMA-IR index was strongly and significantly associated with C-reactive protein (CRP) and interleukin-6 (IL-6) levels in the control group, the association was weaker in the RA group. Among RA patients, higher HOMA-IR levels were associated with rheumatoid factor (RF) seropositivity in men and women, and prednisone use in women only. Before adjustment, higher HOMA-IR levels were associated with all assessed measures of subclinical atherosclerosis in the control group only; associations were diminished and lost statistical significance after adjustment for cardiovascular risk factors. Among the RA patients, neither baseline nor average HOMA-IR levels were significantly associated with change in any of the atherosclerosis measures over an average of 3.2 years of followup. Conclusion Although IR was higher in RA patients than in non-RA controls, higher levels may not independently impart additional risk of atherosclerosis.

AB - Objective Systemic inflammation and insulin resistance (IR) are linked, yet the determinants of IR and its impact on atherosclerosis in rheumatoid arthritis (RA) are incompletely understood. The aim of this study was to explore the prevalence of IR in RA and non-RA populations and investigate whether the associations of IR with measures of atherosclerosis differ between these groups. Methods IR was quantified using the homeostatic model assessment of IR (HOMA-IR), and was compared between RA patients and demographically matched non-RA controls. Differences in the associations between the HOMA-IR index and the Agatston coronary artery calcium (CAC) score, ultrasound-determined intima-media thickness (IMT) of the common carotid artery (CCA) and internal carotid artery (ICA), and focal plaque in the ICA/carotid bulb were compared according to RA status. Results Among the 195 RA patients and 198 controls studied, average HOMA-IR levels were higher in the RA group by 31%, and were consistently higher in the RA group regardless of stratification by demographic or cardiometabolic risk factors. While the HOMA-IR index was strongly and significantly associated with C-reactive protein (CRP) and interleukin-6 (IL-6) levels in the control group, the association was weaker in the RA group. Among RA patients, higher HOMA-IR levels were associated with rheumatoid factor (RF) seropositivity in men and women, and prednisone use in women only. Before adjustment, higher HOMA-IR levels were associated with all assessed measures of subclinical atherosclerosis in the control group only; associations were diminished and lost statistical significance after adjustment for cardiovascular risk factors. Among the RA patients, neither baseline nor average HOMA-IR levels were significantly associated with change in any of the atherosclerosis measures over an average of 3.2 years of followup. Conclusion Although IR was higher in RA patients than in non-RA controls, higher levels may not independently impart additional risk of atherosclerosis.

UR - http://www.scopus.com/inward/record.url?scp=84923599023&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84923599023&partnerID=8YFLogxK

U2 - 10.1002/art.38986

DO - 10.1002/art.38986

M3 - Article

VL - 67

SP - 626

EP - 636

JO - Arthritis and Rheumatology

JF - Arthritis and Rheumatology

SN - 2326-5191

IS - 3

ER -