Hypertension and insulin resistance in rheumatoid arthritis: unveiling insights with mets-ir index

Year 2024, Volume: 15 Issue: 3, 314 - 320, 30.09.2024

Merve Nalbant , Emine Çetin

https://doi.org/10.18663/tjcl.1482825

Abstract

Amaç: Hipertansiyon (HT), patofizyolojisindeki metabolik disfonksiyon ve insülin direnciyle birlikte, RA hastalarında önemli bir kardiyovasküler hastalık risk faktörüdür. Bu nedenle, özellikle RA gibi HT sıklığının arttığı hastalarda, insülin direncinin erken saptanması önemlidir. Çalışmamız, ön planda METS-IR olmak üzere, metabolik indekslerin, RA hastalarında HT öngörü değerini araştırmayı amaçlamıştır.
Gereç ve Yöntemler: Bu retrospektif, kesitsel çalışmaya 80 RA hastası ile yaş ve cinsiyet açısından eşleştirilmiş 80 sağlıklı kontrol dahil edilmiştir. Diyabet, prediyabet veya insülin duyarlılığını etkileyen hastalıklar ile düşük doz glukokortikoidler dışında (<7.5 mg/gün prednizon veya eşdeğeri) glukoz metabolizmasını etkileyen ilaç kullanımı olanlar dışlanmıştır.
Bulgular: RA hastalarında HT sıklığı kontrol grubuna göre anlamlı derecede yüksekti (sırasıyla %65 ve %22.5; p=0.044). HOMA-IR ve METS-IR skorları yine RA grubunda, anlamlı derecede yüksekken (sırasıyla p=0.04 ve p=0.01), QUICKI skorları anlamlı derecede düşüktü (p= 0.04). Glukokortikoid maruziyetinin METS-IR, HOMA-IR veya QUICKI skorlarına etkisi olmadığı izlendi (sırasıyla p=0.410, p=0.583 ve p=0.583). Hipertansif hastaların ortalama HOMA-IR ve METS-IR skorları, hipertansif olmayanlara kıyasla anlamlı derecede yüksekti (sırasıyla p=0.009 ve p<0.001). Çok değişkenli analizlerde, HT ile hem HOMA-IR hem de METS-IR indeksleri anlamlı bir ilişki gösterdi (p=0.002 her ikisi için). Yaşın HT gelişimi üzerinde önemli bir faktör olduğu, yıllık %7 risk artışına yol açtığı gözlenmiştir (p=0.042).
Sonuç: Çalışmamızda HT sıklığının RA hastalarında anlamlı derecede yüksek olduğu ve glukokortikoid kullanımı veya hastalık aktivite durumundan bağımsız olarak METS-IR skorlarının anlamı derecede yüksek olduğunu gösterilmiştir. METS-IR skorunda meydana gelen her bir birimlik artış, RA hastalarında HT gelişme riskinde %15'lik bir artışa neden olmaktadır. METS-IR, bu açıdan HT için pratik bir öngörü aracı olabilir.

Keywords

METS-IR, Romatoid artrit, Hipertansiyon, İnsülin direnci, HOMA-IR, Metabolik indeksler

Hypertension and insulin resistance in rheumatoid arthritis: unveiling insights with mets-ir index

Abstract

Aim: Hypertension (HT), together with metabolic dysfunctions and insulin resistance (IR) in its pathophysiology, is a significant risk factor for cardiovascular disease in rheumatoid arthritis (RA) patients. Identifying IR early could enhance HT management, especially in RA patients, where HT prevalence is elevated. The study aimed to assess metabolic indices, particularly the METS-IR, as predictors of HT in RA patients.
Material and Methods: This retrospective, cross-sectional study investigated the association between RA, IR, and HT in 80 RA patients and 80 age- and sex-matched controls. Patients with diabetes, pre-diabetes, or other conditions affecting insulin sensitivity were excluded, as were those on glucose-metabolism-affecting medications except low-dose glucocorticoids (<7.5 mg/day prednisone or equivalent).
Results: RA patients exhibited significantly higher HT prevalence than controls (65% vs. 22.5%; p=0.044). HOMA-IR and METS-IR scores were significantly higher in RA patients (p=0.04 and p=0.01, respectively), while QUICKI scores were significantly lower (p=0.04). Glucocorticoid use didn’t affect METS-IR, HOMA-IR, or QUICKI scores. Hypertensive patients had significantly higher HOMA-IR and METS-IR scores (p=0.009 and p<0.001, respectively), with both showing a significant association with HT in multivariate analyses (p=0.002 for both). Age emerged as a significant factor in the development of HT, with each passing year increasing the likelihood by 7% (p=0.042).
Conclusion: HT was more prevalent in RA patients, with higher METS-IR levels irrespective of glucocorticoid use or disease activity. Each unit increase in METS-IR score correlated with a 15% higher HT risk. METS-IR could serve as an early prediction tool for HT in RA.

Keywords

METS-IR, Rheumatoid arthritis, Hypertension, Insulin resistance, HOMA-IR, Metabolic Indices

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