THU0146 Glycemic profile and insulin resistance in patients with early rheumatoid arthritis
Authors: A.M. Brandy-García, A. Lorenzo Martín, S. Alonso Castro, M. Alperi López, F.J. Ballina García
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> In established rheumatoid arthritis (RA) there is a high incidence of patients with increased insulin resistance, which can favour the development of Diabetes Mellitus (DM) and the appearance of cardiovascular complications. These aspects, however, have not been studied in depth in patients with early rheumatoid arthritis. <h3>Objectives</h3> To describe the glycemic profile and insulin resistance (IR) in patients with early diagnosis of RA who had not received any background treatment or steroids. <h3>Methods</h3> Observational study in which patients were included 18 years old, diagnosed with RA according to criteria <sup>ACR 1987</sup> and/or ,<sup>ACR-EULAR 2010</sup> from the service of Arthritis of Recent Beginning of the <sup>Hospital Universitario Central de Asturias, between December 2016</sup> and December 2017. In the basal visit, values of insulin, glucose, fasting glycosylated haemoglobin (HbA1c), body mass index (BMI) and abdominal perimeter were collected. In addition, RI and beta cell dysfunction were estimated with HOMA-IR and HOMA-B respectively. <h3>Results</h3> 66 patients were collected, of which 4 were excluded because they were known to be DM and 17 because they had not completed the analytical studies. Of the 45 that were finally studied, 80% (36 patients) are women, the mean age of 54.13±12.9 years, the progression of the disease to diagnosis is 22.8±15.3 weeks, 46.7% (21 patients) are FR and ACPA positive, and the mean disease activity measured by SDAI is 28.03±12.2. Eighteen patients (45%) and 71.1% (31.5 patients) had HOMA-IR, with both 17 patients (37.7%) showing a statistically significant association of SDAI&gt;11 (p=0.001), BMI &gt;24 (p=0.03) and an increased abdominal perimeter (p=0.013). Based on the WHO's diagnostic criteria for DM, 2 patients (4.4%) were diagnosed with DM (all based on a previously unknown HbA1c&gt;6.5%) and 21 (46.7%) as pre-diabetic (14 with glucose between 100–125,16 with HbA1c&gt;5.7 and 9 patients with both alterations). In this subgroup the mean of HOMA-IR and HOMA-B was higher than the mean of the complete sample, 3.4 and 139 respectively. These patients compared with the rest of the sample had a statistically significant association with BMI &gt;24 (p=0.07), SDAI &gt;11 (p=0.01). No correlations were found between these metabolic alterations and the sex, age or positivity for RH. <h3>Conclusions</h3> In patients with AR of less than one year of evolution and who have not received previous treatment with FAME or steroids, a high percentage of RI, pancreatic B cell dysfunction and alterations of the glycemic profile are detected. These alterations are significantly correlated with the presence of overweight and obesity, as well as with the high degree of activity of the disease. Follow-up of these patients is necessary to determine the effect of therapy for rheumatoid arthritis on these metabolic alterations. <h3>Disclosure of Interest</h3> None declared