Background The relationship between insulin resistance (IR) and inflammation in rheumatoid arthritis (RA) is poorly studied. Assume that an effective anti-inflammatory therapy may affect the IR. As IR markers currently used HOMA-IR index and the ratio of leptin/adiponectin (L/A).

Objectives Evaluate the effect of combined treatment with methotrexate (MTX) and TNF-alpha inhibitors on IR in early RA.

Methods In the study included 22 patients (15 female, 7 male) with RA eligible ACR, EULAR 2010, never receiving glucocorticoids and disease-modifying anti-rheumatic drugs. Average age of the patients - 57 [54, 60] years, mean duration of disease - 8 [6.0, 15.0] months, mean DAS28 - 5,9 [5,3; 6,9]. All patients were positive for RF and anti-CCP. The control group consisted of 30 subjects (23 women, 7 men) without rheumatic disease, matched by sex, age and body mass index (BMI) with RA patients. Baseline and after 24 weeks of observation, patients were evaluated by: RA activity (indices DAS, SDAI, CDAI), the index HOMA-IR, adiponectin and leptin concentration, the ratio of leptin/adiponectin (L/A). Level of adipokines was also examined in the control group by ELISA.

Results At study entry adiponectin levels was higher in RA patients than in controls (20.0 [17.8, 34.0] vs 8,6 [5,6;12,2] ng/ml); leptin (25.4 [11.0, 32.0] vs 36,8 [19,0;46,2] ng/ml) and the ratio L/A (1.49 [0.2;1.9] vs 5,31[2,7;6,8]) is lower in RA patients than in controls vs (p<0.05 respectively). All patients with RA was assigned MTX, and after 12 weeks - an inhibitors of TNF-alpha (19 patients - adalimumab, 3 - certolizumab pegol). After 24 weeks of treatment decreased DAS28 (p=0,0001), SDAI (p=0,0006), CDAI (p=0,0003) and adiponectin levels (p=0,008). Leptin levels (p=0,005) and the ratio L/A (p=0,01) significantly increased, HOMA-IR did not change (p=0,2) (table1).

Conclusions The combination therapy of RA antiinflammatory (inhibitors of TNF-alpha, methotrexate) for 24 weeks decreases the activity of RA, but does not improve the performance of IR. The ratio L/A is preferably use at an early stage of the RA for the assessment of IR.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.5239