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FRI0290 Effect of Treatment with Methotrexate and Tnf-Alpha Inhibitors on Insulin Resistance in Early Rheumatoid Arthritis
  1. Y. Gorbunova1,
  2. L. Kondratyeva1,
  3. T. Popkova1,
  4. D. Novikova1,
  5. A. Novikov1,
  6. M. Cherkasova1,
  7. D. Olisaeva2,
  8. O. Fomicheva2,
  9. E. Luchihina1,
  10. E. Alexandrova1,
  11. E. Nasonov1
  1. 1Nasonova Research Institute of Rheumatology, Moscow, Russia
  2. 2Russian Cardiology Research and Production Complex, Moscow, Russia, Moscow, Russian Federation


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).

Table 1

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

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