Adipokines, inflammation, insulin resistance, and carotid atherosclerosis in patients with rheumatoid arthritis

Abstract

IntroductionCardiovascular (CV) morbidity and mortality are increased in patients with rheumatoid arthritis (RA). Inflammation is thought to be an important factor in accelerated atherosclerosis in RA, whereas insulin resistance is a known risk factor for atherosclerosis in RA. We hypothesised that adipokines could be a link between inflammation, insulin resistance, and atherosclerosis in RA.MethodsThe common carotid artery (CCA) intima-media thickness (IMT), CCA resistive index (RI), and carotid plaques were measured by ultrasonography in 192 patients with RA. Insulin resistance was assessed by the homeostasis model assessment for insulin resistance (HOMA-IR). Serum adiponectin, leptin, resistin, tumor necrosis factor-α, and interleukin (IL)-6 concentrations were determined.ResultsThe CCA RI was associated with CCA IMT and the estimated total plaque volume after adjustment for conventional CV risk factors. Among adipokines, resistin and IL-6 were correlated with inflammatory parameters. Leptin and leptin:adiponectin (L:A) ratio were correlated with metabolic risk factors, including HOMA-IR. And L:A ratio was related to the CCA RI after adjustment for conventional and nonconventional CV risk factors, including HOMA-IR, erythrocyte sedimentation rate and C-reactive protein.ConclusionL:A ratio was associated with HOMA-IR and carotid RI. L:A ratio might be an independent factor for predicting cardiovascular risk in patients with RA.

Adipokines in rheumatoid arthritis

“…The high levels of this adipokine in the synovial fluid could suggest a bad prognosis for progression of RA, but the authors point out that more studies are needed to confirm if resistin is a good marker to evaluate the progression of this disease. Kang et al (2013) [23] reinforced this hypothesis. The authors found an association between resistin levels and inflammatory markers in patients with RA.…”

“…Kang et al (2013) [23] demonstrated that TNF-α was positively associated to leptin and the latter was associated with various metabolic risk factors, including insulin resistance. Bustos Rivera-Bahena et al (2015) [24] evidenced that circulating levels of leptin correlate positively with clinical activity of RA, regardless of BMI.…”

Serum Resistin in Lean Rheumatoid Arthritis Patients: Does it correlate with disease activity and radiological joint damage?

“…The results obtained by Kang et al 24 were partially in accordance with ours, as they documented that serum resistin was associated with ESR(P=0.001), CRP(P-0.004) and increased disease duration (P=0.014), while it didn't correlate with DAS 28 or TG. While Rho et al 23 reported that the concentrations of resistin did not differ significantly among patients with seropositive and seronegative RA.…”

Emerging role of leptin in rheumatoid arthritis

“…However, several leptin-cardiovascular risk relations were affected by age, suggesting that younger but not older RA patients may retain obesity-induced endothelial activation that was modulated directly by leptin [128]. Moreover, the leptin : adiponectin (L : A) ratio is concerned with the common carotid artery resistive index, and may be an marker for predicting cardiovascular risk in RA patients [129]. However, the association between leptin and cardiovascular risk in RA is complex; larger studies need to be conducted [130].…”