Inflammation‐associated insulin resistance: Differential effects in rheumatoid arthritis and systemic lupus erythematosus define potential mechanisms

Abstract Background Insulin resistance (IR) is frequently observed in patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). In clinical practice, IR assessment is limited to a low proportion of patients due to cost and equipment and technical expertise requirements. The surrogate index of triglycerides and glucose (TyG index) has been validated in non-rheumatic populations, showing adequate sensitivity and specificity for IR, although this index has not yet been used in connective tissue disorders. The aim of this study was to evaluate the frequency of insulin resistance (IR) using the validated surrogate index of triglycerides and glucose (TyG index) and to explore factors associated with IR in Mexican women with RA or SLE. Methods Ninety-five female RA and 57 SLE patients were included in a cross-sectional study. Clinical and epidemiological variables were evaluated. IR was assessed using the TyG index with a cutoff value of > 4.68. Logistic regression analysis was performed to identify factors associated with IR excluding confounders. Results IR frequency in the entire sample was 50%, higher than the 10% observed in non-rheumatic controls (p < 0.001). The frequency of IR was similar in SLE (49.1%) and RA (50.5%, p = 0.8) patients. IR was associated with a longer duration of hypertension and higher total cholesterol and low density lipoprotein cholesterol levels. Based on multivariate analysis, the duration of hypertension (OR: 1.06; 95% CI 1.002–1.12, p = 0.04), waist circumference (OR: 1.04; 95% CI 1.01–1.08, p = 0.007), uric acid levels (OR: 1.46; 95% CI 1.08–1.97, p = 0.01), RA (OR: 4.87; 95% CI 1.31–18.78, p = 0.01) and SLE (OR: 4.22; 95% CI 1.06–16.74, p = 0.04) were the main risk factors for IR. Conclusions This study shows that the TyG index is a useful screening test for IR in RA and SLE patients. Future longitudinal studies should be performed with the aim of identifying the predictive value of TyG index results for identifying complications linked to IR.

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Insulin Resistance in Pediatric Systemic Lupus Erythematosus and Rheumatoid Arthritis

Suez Canal University Medical Journal ◽

10.21608/scumj.2020.130407 ◽

2020 ◽

Vol 23 (2) ◽

pp. 192-200

Author(s):

Mohamed Talat ◽

Hossam Kamal ◽

Mohamed Abdelsalam ◽

Hesham Ramadan ◽

Hanaa El Said ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systemic Lupus Erythematosus ◽

Insulin Resistance ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Pediatric Systemic Lupus Erythematosus

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Higher Prevalence and Degree of Insulin Resistance in Patients with Rheumatoid Arthritis than in Patients with Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.200435 ◽

2020 ◽

pp. jrheum.200435

Author(s):

Juan C. Quevedo-Abeledo ◽

Hiurma Sánchez-Pérez ◽

Beatriz Tejera-Segura ◽

Laura de Armas-Rillo ◽

Soledad Ojeda ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systemic Lupus Erythematosus ◽

Insulin Resistance ◽

Beta Cell ◽

Lupus Erythematosus ◽

Beta Cell Function ◽

Cell Function ◽

Multivariable Analysis ◽

Model Assessment ◽

Systemic Lupus

Objective Since insulin resistance (IR) is highly prevalent in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), we aimed to determine whether differences in IR between the two conditions exist. Methods Cross-sectional study that encompassed 413 non-diabetic subjects, 186 SLE and 227 RA. Glucose, insulin and C-peptide serum levels, as well as IR by the homeostatic model assessment (HOMA2) were studied. A multivariable regression analysis was performed to evaluate the differences in IR indexes between patients with SLE and RA, and also to determine if IR risk factors or disease-related characteristics are differentially associated with IR in both populations. Results The insulin:C-peptide molar ratio was upregulated in RA compared to SLE patients (beta coef. 0.009 [95%CI 0.005-0.014], p=0.000) after multivariable analysis. HOMA2 indexes related to insulin sensitivity were found to be lower (HOMA2-S% beta coef. -27 [95%CI -46- -9], p=0.004) and beta cell function showed higher IR indexes (HOMA2-B% beta coef. 38 [95%CI 23-52], p=0.000) in RA than in SLE patients after multivariable analysis. RA patients more often fulfilled the definition of IR than those with SLE (odds ratio 2.15 [95%CI 1.25-3.69], p=0.005). The size effect of IR factors on IR indexes was found to be equal in both diseases. Conclusion IR sensitivity is lower and beta cell function is higher in RA than in SLE patients. The fact that traditional IR factors have an equal effect on IR in both SLE and RA supports the contention that these differences are related to the diseases themselves.

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