Effects of DMARD and Anti-TNF Therapies on Inflammatory Markers, Lipid Profile, and Insulin Resistance in Rheumatoid Arthritis: A Controlled Study

Öz

Aim This study aimed to compare the effects of disease-modifying antirheumatic drugs (DMARDs) and anti-tumor necrosis factor (anti-TNF) therapy on inflammatory markers, lipid profile, and insulin resistance in rheumatoid arthritis (RA) patients, and to evaluate the potential cardiovascular impact of biological treatments. Material and Method This single-center, prospective study included 122 participants between May 2012 and May 2013: 35 RA patients treated with DMARDs, 31 RA patients treated with anti-TNF agents, and 56 healthy controls. Inflammatory markers [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF)], lipid profile [total cholesterol, triglycerides, high-density lipoprotein (HDL), atherogenic index of plasma (AIP)], and glycemic parameters [fasting glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR)] were assessed. Results ESR and CRP levels were significantly higher in RA groups compared with controls (p<0.001), and CRP was higher in the anti-TNF group than in the DMARD group. RF positivity was markedly increased in RA patients (p<0.001). No significant differences were found among groups for lipid profile or AIP (p>0.05). Insulin and fasting glucose levels were similar, while HOMA-IR was higher in controls and marginally lower in RA groups (p=0.049). Conclusion RA patients exhibited significantly elevated inflammation, whereas lipid profile and AIP did not differ between treatment groups. Suppression of inflammation was associated with partial improvement in insulin resistance. Cardiometabolic risk in RA should be assessed by considering not only conventional lipid parameters but also inflammation and insulin resistance as multifactorial determinants.

Anahtar Kelimeler

• Rheumatoid Arthritis
• Antirheumatic Agents
• Tumor Necrosis Factor Inhibitors
• Insulin Resistance
• Lipid Metabolism

Etik Beyan

The study was carried out with the permission of the Clinical Research Ethics Committee of Haydarpaşa Numune Training and Research Hospital (Approval No: 2012/8).

Romatoid Artritte DMARD ve Anti-TNF Tedavilerinin İnflamatuvar Belirteçler, Lipid Profili ve İnsülin Direnci Üzerine Etkileri: Kontrollü Bir Çalışma

Öz

Amaç Bu çalışmanın amacı, romatoid artrit (RA) hastalarında hastalık modifiye edici antirromatizmal ilaçlar (DMARD’lar) ile anti-tümör nekroz faktör (anti-TNF) tedavisinin inflamatuvar belirteçler, lipid profili ve insülin direnci üzerindeki etkilerini karşılaştırmak ve biyolojik tedavilerin olası kardiyovasküler etkilerini değerlendirmektir. Gereç ve Yöntem Bu tek merkezli, prospektif çalışmaya Mayıs 2012 ile Mayıs 2013 tarihleri arasında toplam 122 katılımcı dahil edilmiştir: DMARD tedavisi alan 35 RA hastası, anti-TNF ajanları ile tedavi edilen 31 RA hastası ve 56 sağlıklı kontrol. İnflamatuvar belirteçler [eritrosit sedimantasyon hızı (ESR), C-reaktif protein (CRP), romatoid faktör (RF)], lipid profili [toplam kolesterol, trigliserit, yüksek yoğunluklu lipoprotein (HDL), plazmanın aterojenik indeksi (AIP)] ve glisemik parametreler [açlık glukozu, insülin, insülin direncinin homeostaz modeli değerlendirmesi (HOMA-IR)] incelenmiştir. Bulgular ESR ve CRP düzeyleri, kontrol grubuna kıyasla RA gruplarında anlamlı derecede yüksek bulunmuştur (p<0.001) ve CRP düzeyi anti-TNF grubunda DMARD grubuna göre daha yüksek saptanmıştır. RF pozitifliği RA hastalarında belirgin şekilde artmıştır (p<0.001). Lipid profili veya AIP açısından gruplar arasında anlamlı bir fark bulunmamıştır (p>0.05). İnsülin ve açlık glukoz düzeyleri benzer iken, HOMA-IR kontrol grubunda daha yüksek ve RA gruplarında marjinal olarak daha düşük bulunmuştur (p=0.049). Sonuç RA hastalarında inflamasyon belirgin şekilde artmışken, lipid profili ve AIP tedavi grupları arasında farklılık göstermemiştir. İnflamasyonun baskılanması, insülin direncinde kısmi bir iyileşme ile ilişkilendirilmiştir. RA’daki kardiyometabolik risk değerlendirmesi yapılırken yalnızca klasik lipid parametreleri değil, inflamasyon ve insülin direnci gibi çok faktörlü belirleyiciler de dikkate alınmalıdır.

Anahtar Kelimeler

• Romatoid Artrit
• Antirromatizmal Ajanlar
• Tümör Nekroz Faktörü İnhibitörleri
• İnsülin Direnci
• Lipid Metabolizması

Etik Beyan

Çalışma, Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu’nun izniyle gerçekleştirilmiştir (Onay No: 2012/8).

Kaynakça

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