Background Introduction: Response to treatment in rheumatoid arthritis (RA) is a prognostic factor in affected patients. The development of predictors of response to therapy is essential to adequately treat RA patients. Leptin and adiponectin are white fat cell derived hormones with an immunomodulatory role in RA and their levels have been associated with clinical activity in RA.
Objectives Objective: To determine whether baseline levels of leptin, adiponectin predict response to treatment in patients with RA at 6 months, 1 and 2 years of follow-up.
Methods Methods and Patients: Patients were followed at the Rheumatology Clinic and had been diagnosed with RA by a Rheumatologist, fulfilling 1987 ACR classification criteria. All patients received treatment with steroids and/or DMARDs, both in combination or as monotherapy, and visited the clinic every three months where examination and lab testing was performed, including RF, CRP and ESR. A blood sample was taken at a baseline visit between March 2006-December 2008 to determine plasma anti-CCP, leptin and adiponectin (ELISA) levels. Patient follow-up occurred on visits at 6 months and at 1 and 2 years. Descriptive statistics were employed for demographic data and multinomial logistic regression was employed to determine predictors of response to treatment adjusting for potential confounders. Response to treatment was assessed by both the DAS28 score and changes in the DAS28 score from baseline to each time point (EULAR criteria). Correlations were calculated using Spearman’s rho. A p-value of <0.05 was considered as statistically significant.
Results Results: Of 213 patients, 154 completed 6 months follow up, 101 completed 1 year and 61 completed 2 years. 97.2% were women. Mean age was 46.1 years (18-70) and mean time since onset of disease 8.3 years (0-38). Mean BMI was 27.19 (16.5-46.6). 89.6% of patients were RF positive and 71% anti-CCP positive. Most patients received combination therapy at baseline, including at least 2 DMARD (72.7%), the most common being methotrexate (MTX); 16.9% received MTX monotherapy and the rest received prednisone and/or NSAIDs. No patients with biologics were included. Mean leptin plasma levels was 0.57±0.5 ng/ml and for diponectin 140.5±90.3 ng/ml. Multinomial logistic regression analysis showed that adiponectin significantly predicted an improved response to treatment after 6 months of follow up. Patients with higher levels of adiponectin were more likely to show a moderate response to treatment at 6 months (p 0.01) according to EULAR criteria. Adiponectin correlated with changes in DAS28 at 6 months (p 0.02) and 1 year (0.004), while this did not occur in any time period with leptin. BMI correlated with a poor response to treatment at 2 years (p 0.03). Leptin levels predicted remission at 6 months (p 0.0001) and 1 year (p 0.0001), while at 2 years it correlated with a worsening DAS28 score (p 0.0001).
Conclusions Conclusion: Adiponectin may help in predicting an improved response to treatment after 6 months and the BMI predicts poor response to treatment after 2 years.
Disclosure of Interest None Declared