Background:Active Rheumatoid Arthritis (RA) is associated with considerable changes in body composition, lipids, adipokines and insulin sensitivity. RA is an independent risk factor for CVD. The mechanisms leading to synovial inflammation are similar to those found in unstable atherosclerotic plaque. Irisin is a metabolic hormone and a novel adipomyokine related to insulin resistance and endothelial functions (1).Objectives:To investigate the relationship between serum irisin levels, disease activity and cardiovascular risk in RA patients, and to test its performance in predicting subclinical atherosclerosis in RA patients.Methods:60 RA patients fulfilling the 2010 ACR/EULAR RA Classification Criteria and 30 healthy controls were recruited for serological testing of irisin levels. BMI was calculated. Waist/hip ratio was measured. RA disease activity was assessed by DAS28-ESR. Disability was assessed by HAQ-DI in its Arabic version. Serum ESR, CRP, glycated hemoglobin (HbA1c), lipid profile (serum level of cholesterol, triglyceride, HDL, LDL and cholesterol/ LDL ratio), insulin levels were measured in all patients and controls. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was used to calculate insulin resistance. Carotid intimal medial thickness (C-IMT), an indicator of atherosclerosis, was measured by carotid doppler ultrasonography. Echocardiography was performed to assess cardiac abnormalities. Our RA patients were classified twice; first, according to cardiovascular abnormalities and second, according to cut-off values of DAS28.Results:Serum irisin levels were significantly lower in RA patients (9.84 ± 10.56)ng/ml compared to controls (20.48±13.82)ng/ml (p<0.001). BMI values were significantly higher in all patients than controls (P= 0.035), while waist/hip ratio in female patients only were significantly higher (P= 0.007).We found a negative correlation between serum irisin and DAS28-ESR (r = -0.455, P-value 0.005)& HAQ-DI (r = -0.309, P-value 0.016). There was a negative correlation between serum irisin level and parameters of cardiovascular risk including anthropometric measurements (BMI and waist/hip ratio), HOMA-IR (r=−0.371, p=0.009) and C-IMT (r=−0.511, p<0.001). No correlation could be detected between irisin and lipid profile. The frequency of cardiovascular (CV) involvement in RA patients was 45% (27 patients) (11.6 % with echocardiographic abnormalities and 40% having increased C-IMT). Patients with CV involvement showed lower serum irisin level, increased disease activity assessed by DAS28 and increased disease disability assessed by HAQ-DI with statistically significant difference (P < 0.001, P < 0.05 and P < 0.001 respectively). Classifying the patients based on cut-off values of DAS28 into 3 groups (low disease activity, moderate and high disease activity), we found a statistically significant difference between the irisin levels of the 3 groups, being lowest among highly active patients (P= 0.014). c-IMT values were significantly higher in highly active patients (P= 0.04). Assessing the biomarker’s performance as an independent indicator of subclinical atherosclerosis in RA patients using ROC curve, it showed an excellent ability (AUC 0.8, P <0.001). As regarding its ability to differentiate patients with high disease activity, it showed a very good performance (AUC 0.73, P <0.001).Conclusion:In RA patients, serum irisin level was significantly lower and perform better than traditional yardsticks in identifying disease activity. It may act as an independent indicator of subclinical atherosclerosis in RA patients. Serum irisin level may be responsible for increased cardiovascular risk in those patients.References:[1]Chen JQ, Huang YY, Gusdon AM, Qu S.Irisin: a new molecular marker and target in metabolic disorder. Lipids Health Dis. 2015 Jan 14; 14:2.Disclosure of Interests:None declared
Background: chronic inflammatory disorders such as rheumatoid arthritis are associated especially active disease are associated with disturbed glucose and lipid metabolism, this underlying metabolic disorders such as insulin resistance. Objectives: The aim of this study was to determine insulin resistance and its relation to disease activity in patients with RA. Methods: Sixty RA patients fulfilling the 2010 ACR/EULAR RA Classification Criteria were included in the study. Thirty ageand sex-matched healthy volunteers were enrolled as the control group. All subjects underwent full history taking, clinical examination. BMI was calculated. Waist/hip ratio was measured. RA disease activity was assessed by DAS28-ESR. The following laboratory investigations were done for all patients and control: HbA1c, lipid profile and insulin. Insulin resistance was assessed with the HOMA Index. Echocardiography for cardiac abnormalities. Results: The frequency of cardiovascular (CV) involvement in our RA patients was 11.6% with echocardiography. Patients had higher insulin resistance than controls with no statistically significant difference. RA patients with CV involvement showed increased disease activity in comparison with patients without CV involvement, and no significant difference in insulin levels nor resistance between them. Conclusions: Rheumatoid arthritis has higher insulin resistance than controls, with no correlation to disease activity.
ZES = 4) and 154 patients were referred for CABG after angiography due to higher grades of ISR (proliferative and total in 165, p < 0.001). Interestingly in 31 cases of DES stenting, new lesions formed alongside with DES ISR. The mean time to next ISR was 9.5 AE 3.5 months and was significantly lesser ( p < 0.01) compared to time to first ISR irrespective of DES stent type for the first ISR. Conclusions: ISR occurs significantly earlier in stenting in ACS situations than for SIHD. BMS usage was significantly associated with higher grades of proliferative ISR and more likely needed CABG while DES ISR was more likely to be focal. CSA was the commonest presenting complaint with ISR. Other predictors were smaller stent size (2.5 mm) and longer stent length >24 mm, male gender, complex PCI in bifurcation lesions with two-stent strategy (any technique), PCI in CTO lesions, PCI done in low EF (<35%). However, no relation of future ISR was seen with the use of same or hetero-DES after the first ISR episode among DES usage.
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