Insulin resistance and impaired beta cell function in rheumatoid arthritis
Abstract
Objective: To identify factors that regulate glucose metabolism in rheumatoid arthritis (RA). Methods: We evaluated the homeostatic model assessment of insulin resistance (HOMA‐IR) and beta cell function (HOMA‐B) in 94 RA patients. We investigated the relationship between characteristics known to affect glucose metabolism in the general population (age, abdominal obesity [waist circumference], hypertension, antihypertensive therapy) as well as characteristics of RA (disease activity, glucocorticoid therapy) and insulin resistance and beta cell function. Results: Patients with high‐grade inflammation (high‐sensitivity C‐reactive protein value >1.92 mg/liter) (n = 81) were more insulin resistant than patients with low‐grade inflammation (n = 13), whereas beta cell function was similar in both groups. Insulin resistance and beta cell function were similar in both groups after adjustment for waist circumference. All recorded characteristics except for age were associated with HOMA‐IR or/and HOMA‐B in univariate analyses. In mixed regression models, abdominal obesity and patient's assessment of disease activity (by visual analog scale) were predictors of insulin resistance. The Disease Activity Score assessed using 28‐joint counts for swelling and tenderness, tender joint count, and patient's assessment of disease activity were associated with reduced beta cell function, and the cumulative dose of glucocorticoids was associated with enhanced beta cell function. The cumulative glucocorticoid dose in all study patients was a mean of only 536 mg (95% confidence interval 239–1,173). In patients with high‐grade inflammation, age was further associated with impaired beta cell function, whereas use of angiotensin‐converting enzyme inhibitors or angiotensin II type 1 receptor blockers was associated with enhanced beta cell function. Conclusion: The modifiable factors of abdominal obesity, antihypertensive therapy, disease activity, and use of glucocorticoids appear to affect glucose metabolism in RA.
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As systemic inflammation also impairs insulin sensitivity, the effects of GCs on various fluxes, given their combined anti-inflammatory and metabolic effects, could be more complex in patients with chronic inflammatory diseases.
“As systemic inflammation also impairs insulin sensitivity [44], the effects of GCs on various fluxes, given their combined anti-inflammatory and metabolic effects, could be more complex in this population.”
From Low-dose glucocorticoid treatment affects multiple aspects of intermediary metabolism in healthy humans: a randomised controlled trial (2011) · cites this paper as [44]
In chronic inflammatory diseases such as rheumatoid arthritis and systemic lupus erythematosus, hyperinsulinemia and insulin resistance have been described.
“In CIDs such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), hyperinsulinemia and insulin resistance were described [85-87].”
From Interaction of the endocrine system with inflammation: a function of energy and volume regulation (2014) · cites this paper as [86]
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- Authors
- Dessein, P. H., & Joffe, B. I.
- Affiliations
- University of the Witwatersrand (ZA)
- ORCID
- Dessein, Patrick H.
- Venue
- Arthritis & Rheumatism
- Publisher
- Wiley
- Published
- 2006-08-31
- Volume
- 54
- Issue
- 9
- Pages
- 2765-2775
- ISSN
- 0004-3591 (ISSN-L)
- 1529-0131
- OpenAlex
- W2061390926
- Cited by
- 218
- References
- 50
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 7 · 2023: 3 · 2022: 9 · 2021: 9 · 2020: 7 · 2019: 10 · 2018: 15 · 2017: 9 · 2016: 14 · 2015: 15 · 2014: 17 · 2013: 20 · 2012: 13
- FWCI
- 6.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arthritis & Rheumatism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- rheumatoid arthritis, insulin resistance, beta-cell function, glucose metabolism, disease activity, C-reactive protein, abdominal obesity, glucocorticoid therapy, ACE inhibitors, angiotensin receptor blockers, antihypertensive therapy
- MeSH terms
- Arthritis, Rheumatoid, Blood Glucose, Blood Pressure, C-Reactive Protein, Diabetes Mellitus, Female, Homeostasis, Humans, Inflammation, Insulin Resistance, Islets of Langerhans, Male, Middle Aged, Models, Biological, Obesity, Body Mass Index, Body Size
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