Lu Ye1, Xin Zhang1, Huaxiang Wu1, Yahui Chen1, Haibo Zhou2, Qiaohong Wang1, Weihong Xu1

1Department of Rheumatology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
2Department of Gastroenterology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China

Keywords: Abnormal lipid level, disease activity, insulin resistance, very early rheumatoid arthritis.


Objectives: This study aims to evaluate the presence and factors related to insulin resistance (IR) in untreated very early rheumatoid arthritis (RA) patients.

Patients and methods: Between June 2020 and July 2021, a total of 90 RA patients (29 males, 61 females; mean age: 49.3±10.2 years; range 24 to 68 years) and 90 age-, sex- and body mass index (BMI)-matched controls (35 males, 55 females; mean age: 48.3±5.1 years; range 38 to 62 years) were included. Homeostatic model assessment was applied to evaluate IR (HOMA-IR) and β-cell function (HOMA-β). Disease activity score 28 (DAS28) was used to estimate disease activity. Lipid profile, hemoglobin A1c (HbA1c), glucose, insulin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were measured. Logistic regression analysis was performed to investigate the relationship between the IR and clinical features of RA patients.

Results: The RA patients had higher HOMA-IR values (p<0.001) and adverse lipid profile. The IR was positively correlated with age (r=0.35, p<0.01), CRP (r=0.42, p<0.001), ESR (r=0.33, p<0.01), disease duration (r=0.28, p<0.01), and DAS28 (r=0.50, p<0.001). The DAS28, CRP and age, but not sex and menopausal status, were independently associated with IR.

Conclusion: Insulin resistance was present in untreated very early RA patients. The DAS28, CRP, and age were independent predictors for the presence of IR. Based on these findings, RA patients should be evaluated early for the presence of IR to reduce the risk of metabolic diseases.

Citation: Ye L, Zhang X, Wu H, Chen Y, Zhou H, Wang Q, et al. Insulin resistance and adverse lipid profile in untreated very early rheumatoid arthritis patients: A singlecenter, cross-sectional study in China. Arch Rheumatol 2022;37(4):593-602.

Ethics Committee Approval

The study protocol was approved by the School of Medicine, The Second Affiliated Hospital of Zhejiang University (IR2020001179). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Statistical analysis and manuscript writing: Y.L.; study design, interpretation of data: X.W.H.; statistical analysis and interpretation of data; W.H.X.; data collection and statistical analysis: Z.X., C.Y.H.; data collection, statistical analysis and interpretation of data: Z.H.B., W.Q.H.; All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

This work was supported by Zhejiang Provincial Natural Science Foundation of China (grant number LQ15H070003).