THU0175 Assesment of insulin resistance in a rheumatoid arthritis inception cohort: nested case-control study
Authors: S. Manrique-Arija, N. Mena-Vázquez, I. Ureña-Garnica, S. Abad-Sanchez, L. Ginel, C. Fuego-Varela, M. Rojas-Gimenez, L. Cano-Garcia, F.G. Jimenez-Nuñez, G. Diaz-Cordoves, M.C. Ordoñez-Cañizares, C.M. Romero-Barco, R. Caparrós, M.V. Irigoyen, A. Fernandez-Nebro
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> To asses insulin resistance (IR) in patients with rheumatoid arthritis (RA) and compare it with healthy controls and to analyse the association between the accumulated inflammatory burden in patients with RA and IR <h3>Methods</h3> Design: Nested case-control study. Population: consecutive RA-patients (ACR/EULAR 2010 criteria),&gt;16 years, selected from a prospective inception cohort (diagnosis of RA between 2007 and 2011). Patients with Diabetes Mellitus (according to ADA 2010 criteria) were excluded. Controls: sex- age and BMI -matched controls were collected from a health centre in our hospital area. Protocol: Cases and controls were evaluated by a rheumatologist. Clinical data of disease activity (RA patients), analytical values and oral glucose tolerance test (OGTT) were determined. Main outcome: IR measured by the homeostasis model for insulin resistance (HOMA-IR) (IR &gt;2.29μU*mmol/ml). Secondary outcome: RI measured by quantitative insulin sensitivity check index (QUICKI) (&lt;0.337μU *mmol/ml) and by the homeostatic model assessment of β-cell function (HOMA ß).Variables: Demographic, clinical-analytical variables, Disease Activity Score of 28 joints (DAS28-ESR), Health Assessment Questionnaire (HAQ), BMI (OMS classification) and glucose and insulin before and after OGTT values. Statistical analysis: Descriptive and paired T-test or Chi-square test followed by Multivariate linear regression in RA patients (Dependent variable: HOMA-IR) <h3>Results</h3> One hundred and fifty six subjects were studied, 4 of them were excluded after OGTT(2 diabetics and their respective controls). Finally, 1522 subjectswer included; 89 RA and 63 controls. The mean age of patients with RA was 56.6 (10.9%)years. Most of them were women(76.4%), with seropositive(FR 83.1% y ACPA 79.1%) and erosive (62%) RA. The mean duration of the disease was 86 (±23)months and mean DAS28 index at the cut-off date of 2.8 (±1.1). Differences between clinical characteristics and in relation to IR between cases and controls are shown in table 1. No significant differences in the proportion of subject with IR in cases and controls were observed and 28.7% of patients with RA had IR. Of the 25 patients with IR, 75% had an average of DAS28 ≥3.2. In multivariate analysis, the independent variables associated with IR in patients with RA were: Obesity(β=1.7494[p=0.003]), diagnosis delay (β=0.034 [p=0.003]) and disease activity (β=1.045[p=0.058]). This model would explain 23% of the variability of the IR (R<sup>2</sup>=0.23). <h3>Conclusions</h3> We did not find an increased IR in patients with RA compared with healthy controls, which may be due to adequate treatment and good control of inflammatory activity in the most of patients with RA. Obesity, diagnostic delay and inflammatory activity (measured by mean DAS28 index since the onset of the disease), were the predictors of IR in patients with RA in our study <h3>References</h3> [1] Clin Rheumatol2016;35(1):43–53. [2] Review. Front Immunol2017;8:1745. [3] Rev Bras Reumatol Engl Ed2017;57(4):320–329. [4] Biomed Res Int2017:9670434. <h3>Disclosure of Interest</h3> S. Manrique-Arija Grant/research support from: Rheumatology Spanish Society, N. Mena-Vázquez: None declared, I. Ureña-Garnica: None declared, S. Abad-Sanchez: None declared, L. Ginel: None declared, C. Fuego-Varela: None declared, M. Rojas-Gimenez: None declared, L. Cano-Garcia: None declared, F. Jimenez-Nuñez: None declared, G. Diaz-Cordoves: None declared, M. Ordoñez-Cañizares: None declared, C. Romero-Barco: None declared, R. Caparrós: None declared, M. Irigoyen: None declared, A. Fernandez-Nebro: None declared