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Insulin resistance and endothelial dysfunction in rheumatoid arthritis
Rheumatoid arthritis is a chronic inflammatory disease, in which, besides articular involvement, cardiovascular complications due to premature and accelerated atherosclerosis represent a serious problem. Endothelial dysfunction is the first step in the atherosclerosis development. Rheumatoid arthritis associated inflammation contributes to endothelial dysfunction through direct action of cytokines on endothelium, or via increased insulin resistance. The aim of this study was represented by the assessment of endothelial dysfunction in rheumatoid arthritis patients, and correlation of this with impaired insulin sensitivity.
Material and methods. The study was performed on a group of 35 patients with newly diagnosed rheumatoid arthritis. In all patients were assessed: rheumatoid arthritis activity (DAS28), insulin resistance (HOMA-IR) and endothelial dysfunction by means of flow-mediated dilation (FMD).
Results. Inflammation was present in all patients, and the disease activity was high (DAS28: 6.41 ± 0.94). The studied patients showed high insulin resistance (HOMA-IR 5.97 ± 1.89) and endothelial dysfunction (FMD 7.94 ± 0.91%). There were significant correlations between endothelial dysfunction and insulin resistance (p = 0.0174), respective disease activity (p = 0.0201). On the other hand, it was shown a correlation between insulin resistance and the disease activity (p = 0.0290).
Conclusion. Endothelial dysfunction was present even in newly diagnosed rheumatoid arthritis patients, contributing to the development of later atherosclerotic cardiovascular disease. Insulin resistance represented an important factor involved in endothelial dysfunction appearance.
Keywords: endothelial dysfunction, insulin resistance, rheumatoid arthritis