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AB0293 Metabolic syndrome and insulin resistance in adult egyptian females with rheumatoid arthritis
  1. AA-R Youssef1,1,
  2. NO Neseem1,
  3. MA-B Omar2,
  4. OM El-Siri1
  1. 1Rheumatology & Rehabilitation
  2. 2Clinical Pathology, Mansoura University, Mansoura, Egypt

Abstract

Background Patients with Rheumatoid Arthritis (RA) have an increased risk for cardiovascular disease (CVD) due to higher prevalence of traditional risk factors (1), Insulin resistance (IR) is implicated in inflammatory diseases such as RA (2). The prevalence of Met.Syn and IR in Egyptian female RA patients has not been studied before.

Objectives To find out the prevalence of Met.Syn and IR in a cohort of Egyptian females with RA and in controls and to study the associated risk factors

Methods 60 female RA patients and 30 healthy females matched for age were included according to the ACR/EULAR 2010 classification criteria. Disease activity was assessed using DAS- 28. IR using HOMA- index (HOMA- IR) (3) Met.Syn was defined according to the updated third report of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP III) criteria (4).

Results Prevalence of Met.Syn in female RA patients is significantly (sig.) higher (56.7%) than that of controls (33.3%, P=0.04). IR is prevalent in RA patients (63.4%), Patients with Met.Syn exhibited sig. higher serum levels of TG (P<0.001,) FBG (P=0.02), CRP (P=0.02), Fasting insulin (P=0.01) and IR (P=0.03) than those without. Median CRP (24) and mean DAS- 28 (5.6±1.5) in RA patients with increased IR are sig. higher than those of RA Patients with normal IR (6.5, P<0.01) & (4.7±1.5 P<0.04) respectively. Significant positive correlation was found between DAS-28 and IR (Rs =0.3, P=0.03). Using logistic regression, high systolic blood presser (OR =1.2, 95% CI: 1.02 – 1.39, P=0.03) and elevated CRP (OR =1.07, 95% CI: 1.01 – 1.14, P=0.04) have shown to be the significant independent predictors for the development of Met.Syn

Conclusions Met.Syn. and IR are prevalent in female Egyptian RA patients adding to the CV risk of the disease and both are related to increased disease activity. Rheumatologists should pay an attention to control RA disease activity in addition to screen patients for components of the Met.Syn and introduce appropriate treatment strategies. Further studies are warranted to get more conclusive results.

References

  1. Gremese, E., & Ferraccioli, G. (2011). The metabolic syndrome: the crossroads between rheumatoid arthritis and cardiovascular risk. Autoimmunity Reviews, 10(10), 582–589.

  2. Goodwin, P. J., Ennis, M., Bahl, M., Fantus, I. G., Pritchard, K. I., Trudeau, M. E., ... & Hood, N. (2009). High insulin levels in newly diagnosed breast cancer patients reflect underlying insulin resistance and are associated with components of the insulin resistance syndrome. Breast Cancer Research and Treatment, 114(3), 517–525.

  3. Reilly, M. P., Wolfe, M. L., Rhodes, T., Girman, C., Mehta, N., & Rader, D. J. (2004). Measures of insulin resistance add incremental value to the clinical diagnosis of metabolic syndrome in association with coronary atherosclerosis. Circulation, 110(7), 803–809.

  4. Grundy, S. M., Cleeman, J. I., Daniels, S. R., Donato, K. A., Eckel, R. H., Franklin, B. A., ... & Spertus, J. A. (2005). Diagnosis and management of the metabolic syndrome an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation, 112(17), 2735–2752.

References

Acknowledgements We acknowledge the efforts received by all staff members of departments of Rheumatology and clinical pathology at Mansoura University Hospital, Egypt.

Disclosure of Interest None declared

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