Background Visfatin is a proinflammatory cytokine (adipocytokine) that is secreted in excess from adipose tissue in obese individuals, and it has numerous metabolic and autoimmune implications: it stimulates the secretion of IL-6, IL-8, IL-10, IL-18 and TNF-α. In SLE patients these may influence disease activity and delays remission (1).
Objectives To assess the possible effects of obesity & serum visfatin levels on SLE patients and its clinical relevance on disease process, activity and occurrence of insulin resistance.
Methods This study was performed on 60 SLE patients satisfying the 1997 American College of Rheumatology revised criteria (ACR) and 60 apparently normal individuals with matched age and sex as control groups. All subjects were classified according to BMI into 4 groups (non-obese and obese SLE patients, non-obese and obese control persons). All patients were subjected to full history & clinical examination, assessment of SLE disease activity was done using BILAG-2004 index, laboratory investigations were done (CBC, ESR, fasting blood glucose, renal and liver function tests, lipids profile, fasting plasma insulin, calculation of insulin resistance by HOMA score, measurement of serum visfatin level by ELISA kit) and diagnosis of metabolic syndrome according to WHO definition.
Results There were statistically significant higher grades of cardiorespiratory manifestations of BILAG score in obese compared to non-obese SLE patients. 40% of obese lupus patients were hypertensive, while only 16.6% of non-obese SLE patients A statistically significant higher prevalence of metabolic syndrome in obese compared to non-obese SLE patients. There were statistically significant higher levels of total serum cholesterol; serum triglyceride, fasting blood sugar, fasting insulin, insulin resistance and serum visfatin; but lower level of HDL in obese SLE patients compared to non- obese SLE. The same observations were recorded on comparing non-obese SLE patients to non-obese controls & obese SLE to obese controls. A statistically significant higher level of insulin resistance and prevalence of metabolic syndrome were found among obese SLE patients when compared to obese controls and non-obese SLE patients compared to non-obese controls. Regarding serum visfatin levels obese SLE patients have significantly higher serum visfatin levels than non-obese SLE patients than obese controls than non-obese controls.In all SLE patients there were statistically significant positive correlations between serum visfatin levels and each of: BMI, waist circumference, haematological manifestations, total BILAG score of disease activity, serum triglycerides, liver functions (ALT, AST, alkaline phosphatase and total serum proteins). While a significant negative with HDL level.
Conclusions Obesity (BMI) is an independent risk factor in SLE patients that increases the SLE disease activity and complications. Visfatin is an adipocytokine its level significantly increased in obese SLE patients & it is positively correlated with disease activity.
Ouchi N, Parker JL, Lugus JJ and Walsh K.Nat Rev Immunol 2011; 11: 85–97.
Acknowledgements We thanks all the participating patients.
Disclosure of Interest None declared