Impact of TNF inhibition on insulin resistance and lipids levels in patients with rheumatoid arthritis |
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Authors: | Lai-Shan Tam Brian Tomlinson Tanya T Chu Tena K Li Edmund K Li |
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Institution: | (1) Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China |
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Abstract: | Patients with rheumatoid arthritis (RA) have increased cardiovascular mortality. TNF-α is a critical mediator of inflammation
and metabolic response in patients with RA. Increased insulin resistance and dyslipidemia were known risk factors in patients
with active RA, however, the regulation of these metabolic parameters by TNF-α is poorly understood. Neutralization of TNF-α
with infliximab offers a unique opportunity to study TNF-α-mediated regulation of these metabolic parameters in RA. The aim
of the study was to assess the in vivo TNF-α-mediated regulation of insulin resistance and lipids levels in RA. Nineteen patients
with active RA treated with infliximab were prospectively followed for 14 weeks. Plasma lipids levels and insulin resistance
were measured at baseline, 6 and 14 weeks after infliximab treatment. At week 14, the disease activity (DAS-28 score) improved
significantly (p < 0.000), with a significant reduction in both C-reactive protein (p = 0.007) and erythrocyte sedimentation rate (p = 0.006) levels. The body weight did not change during the study period. After infliximab treatment, insulin resistance improved
as reflected by the significant reduction in the Homeostasis Model Assessment Index. Total cholesterol, HDL-cholesterol, LDL-cholesterol,
triglycerides, and apolipoprotein B (apoB) levels all increased significantly from baseline. Nonetheless, the atherogenic
index, LDL-cholesterol/HDL-cholesterol ratio, and the LDL/apoB ratio remained unchanged. Infliximab improves insulin sensitivity
and alters lipid profile in patients with active RA. |
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Keywords: | Insulin resistance Lipid profile Rheumatoid arthritis TNF blocker |
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