期刊
JOURNAL OF RHEUMATOLOGY
卷 41, 期 10, 页码 1974-1979出版社
J RHEUMATOL PUBL CO
DOI: 10.3899/jrheum.140224
关键词
SKELETAL MUSCLE; INSULIN RESISTANCE; PHYSICAL ACTIVITY; BODY COMPOSITION
类别
资金
- US National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases [K23AR054904]
- American College of Rheumatology-Rheumatology Research Foundation (ACR-RRF)/Association for Specialty Professors (ASP) Junior Career Development Award in Geriatric Medicine - Atlantic Philanthropies, ACR-RRF, John A. Hartford Foundation
- ASP
- Central Society for Clinical Research
Objective. In prior reports, individuals with rheumatoid arthritis (RA) exhibited increased insulin resistance. However, those studies were limited by either suboptimal assessment methods for insulin sensitivity or a failure to account for important determinants such as adiposity and lack of physical activity. Our objectives were to carefully assess, compare, and determine predictors of skeletal muscle insulin sensitivity in RA, accounting for adiposity and physical activity. Methods. Thirty-nine individuals with established (seropositive or erosions) and treated RA and 39 controls matched for age, sex, race, body mass index, and physical activity underwent a frequently sampled intravenous glucose tolerance test to determine insulin sensitivity. Inflammation, body composition, and physical activity were assessed with systemic cytokine measurements, computed tomography scans, and accelerometry, respectively. Exclusions were diabetes, cardiovascular disease, medication changes within 3 months, and prednisone use over 5 mg/day. This investigation was powered to detect a clinically significant, moderate effect size for insulin sensitivity difference. Results. Despite elevated systemic inflammation [interleukin (IL)-6, IL-18, tumor necrosis factor-a; p < 0.05 for all], persons with RA were not less insulin sensitive [SI geometric mean (SD): RA 4.0 (2.4) vs control 4.9 (2.1)*10(-5) min(-1)/(pmol/l); p = 0.39]. Except for visceral adiposity being slightly greater in controls (p = 0.03), there were no differences in body composition or physical activity. Lower insulin sensitivity was independently associated with increased abdominal and thigh adiposity, but not with cytokines, disease activity, duration, disability, or disease-modifying medication use. Conclusion. In established and treated RA, traditional risk factors, specifically excess adiposity, play more of a role in predicting skeletal muscle insulin sensitivity than do systemic inflammation or other disease-related factors.
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