Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Long-Term Effect of Anti TNF-Alpha Therapies on Insulin Resistance, Body Composition and Adipokines in Rheumatoid Arthritis Patients.

Delgado-Frias3,  Esmeralda, Hernandez-Hernandez2,  Vanesa, Ferraz-Amaro1,  Iván, Quevedo1,  Juan Carlos, Muniz,  Jose R., Arce-Franco,  Maria T., Lopez-Fernandez,  Judith

La Laguna, S/C Tenerife, Spain
La Laguna, S/C Tenerfe, Spain
Hospital Universitario de Canarias, Tenerife, La Laguna, S/C Tenerife, Spain

Introduction:

It has been suggested that tumor necrosis factor alpha (TNFalpha), a cytokine that plays a key role in rheumatoid arthritis (RA) pathogenesis, may act as a link between inflammation and cardiovascular disease apparently through several effects including the induction of insulin resistance (IR). The purpose of this study was to clarify if long-term modulation of inflammatory activity by TNFalpha inhibitors has some influence on insulin sensitivity, and if this effect is related to changes in body fat distribution, body composition, physical activity or levels of adipokines (cytokines secreted by adipocytes) in active RA patients.

Methods:

Sixteen patients with RA (mean age 50.8±14.6 years, mean duration of disease 6.3±2.7 years) who were receiving anti-TNFalpha agents in addition to methotrexate because of active disease were followed up during one year. Disease activity was assessed by DAS28 (Disease Activity Score), IR was determined by using Homeostatic Model Assessment-2, body composition was evaluated by multifrequency bioelectric impedance analysis, physical activity by accelerometry, abdominal fat distribution by magnetic resonance imaging, and serum level of several key adipokines were quantified by ELISA. All examination and assessments were done at baseline (prior to TNF-alpha treatment) and after 3 and 12 months of treatment.

Results:

Body mass indices had increased significantly after one year (25.7±3.2 vs 28.06±4.5 kg/m2, p=0.02) of treatment with anti-TNFalpha. Body composition in terms of fat and fat-free mass had not changed between visits except for a significant elevation of body cell mass (25.5±4.6 vs 26.6±3.1 kg, p=0.02). Values of visceral intraabdominal and subcutaneous abdominal adipose tissue were not modified due to treatment. In spite of a significant improvement in DAS28, patients' physical activity remained stable during the follow up. Basal levels of insulin resistance, beta cell function production or insulin sensitivity did not change along the study. Only insulin sensitivity exhibited a significant increase after 3 months (110[94–138] vs 118[107–156]%, p=0.045) but no longer by the end of the study. Basal levels of adiponectin, visfatin, leptin, ghrelin, resistin, and apelin did not change in response to anti-TNFalpha treatment; only retinol binding protein 4 showed a significant change (51.7±32.7 vs 64.9±28.4 mg/mL, p=0.03) at the end of the study.

Conclusions:

Insulin resistance, adiposity, body composition, and adipokine serum levels are not significantly affected by long-term inhibition of TNFalpha in RA patients. Our findings question the suggested beneficial role of anti-TNFalpha treatments in insulin resistance.

To cite this abstract, please use the following information:
Delgado-Frias, Esmeralda, Hernandez-Hernandez, Vanesa, Ferraz-Amaro, Iván, Quevedo, Juan Carlos, Muniz, Jose R., Arce-Franco, Maria T., et al; Long-Term Effect of Anti TNF-Alpha Therapies on Insulin Resistance, Body Composition and Adipokines in Rheumatoid Arthritis Patients. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :389
DOI: 10.1002/art.28158

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