TY - JOUR
T1 - Seropositivity is associated with insulin resistance in patients with early inflammatory polyarthritis
T2 - Results from the Norfolk Arthritis Register (NOAR); An observational study
AU - Mirjafari, Hoda
AU - Farragher, Tracey M.
AU - Verstappen, Suzanne M M
AU - Yates, Allen
AU - Bunn, Diane
AU - Marshall, Tarnya
AU - Lunt, Mark
AU - Symmons, Deborah P M
AU - Bruce, Ian N.
PY - 2011/9/29
Y1 - 2011/9/29
N2 - Introduction: Cardiovascular disease (CVD) is the leading cause of death in patients with inflammatory polyarthritis (IP) especially in seropositive disease. In established RA, insulin resistance (IR) is increased and associated with CVD. We investigated factors associated with IR in an inception cohort of patients with early IP. Methods: Patients with early IP ([greater than or equal to]2 swollen joints for [greater than or equal to]4 weeks), aged 18-65 years, seen within 24 months of symptom onset were recruited from the Norfolk Arthritis Register (NOAR), a primary-care-based inception cohort. Assessment included joint examination, current and prior therapy and completion of the Health Assessment Questionnaire. Fasting blood was taken for measurement of CVD risk factors, rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA), C-reactive protein (CRP), and insulin levels. IR was calculated using the homeostatic model assessment (HOMA-IR). We examined factors associated with IR using univariate and multivariable linear regression models. Results: One-hundred-and-ninety-six patients, including 59 (30%) males, were studied with a median (IQR) age and IP symptom duration of 49 (40-57) years and 6.7 (4.6-10.7) months respectively. After age and gender adjustment, HOMA-IR was associated with obesity, [beta-Coefficient (95% CI); 1.60 (0.96, 2.24)], higher systolic and diastolic blood pressure [0.03 (0.01, 0.05) and 0.04 (0.01, 0.08) respectively], triglycerides [1.06 (0.54, 1.57)], and HDL [-1.38 (-2.17,-0.58)]. HOMA-IR was associated with serological status and this association persisted after adjustment for classic CVD risk factors and other IP-related variables [RF beta-Coefficient (95% CI); 0.87 (0.20, 1.53) and ACPA beta-Coefficient (95% CI); 1.42 (0.70, 2.15)]. Conclusions: Seropositivity for RF or ACPA was associated with IR in this early IP cohort. This association may, in part, explain why seropositive patients have excess CVD mortality.
AB - Introduction: Cardiovascular disease (CVD) is the leading cause of death in patients with inflammatory polyarthritis (IP) especially in seropositive disease. In established RA, insulin resistance (IR) is increased and associated with CVD. We investigated factors associated with IR in an inception cohort of patients with early IP. Methods: Patients with early IP ([greater than or equal to]2 swollen joints for [greater than or equal to]4 weeks), aged 18-65 years, seen within 24 months of symptom onset were recruited from the Norfolk Arthritis Register (NOAR), a primary-care-based inception cohort. Assessment included joint examination, current and prior therapy and completion of the Health Assessment Questionnaire. Fasting blood was taken for measurement of CVD risk factors, rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA), C-reactive protein (CRP), and insulin levels. IR was calculated using the homeostatic model assessment (HOMA-IR). We examined factors associated with IR using univariate and multivariable linear regression models. Results: One-hundred-and-ninety-six patients, including 59 (30%) males, were studied with a median (IQR) age and IP symptom duration of 49 (40-57) years and 6.7 (4.6-10.7) months respectively. After age and gender adjustment, HOMA-IR was associated with obesity, [beta-Coefficient (95% CI); 1.60 (0.96, 2.24)], higher systolic and diastolic blood pressure [0.03 (0.01, 0.05) and 0.04 (0.01, 0.08) respectively], triglycerides [1.06 (0.54, 1.57)], and HDL [-1.38 (-2.17,-0.58)]. HOMA-IR was associated with serological status and this association persisted after adjustment for classic CVD risk factors and other IP-related variables [RF beta-Coefficient (95% CI); 0.87 (0.20, 1.53) and ACPA beta-Coefficient (95% CI); 1.42 (0.70, 2.15)]. Conclusions: Seropositivity for RF or ACPA was associated with IR in this early IP cohort. This association may, in part, explain why seropositive patients have excess CVD mortality.
U2 - 10.1186/ar3476
DO - 10.1186/ar3476
M3 - Article
C2 - 21959060
SN - 1478-6354
SP - R159
JO - Arthritis Research and Therapy
JF - Arthritis Research and Therapy
ER -
