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dc.contributor.authorStavropoulos-Kalinoglou, A
dc.contributor.authorMetsios, GS
dc.contributor.authorPanoulas, VF
dc.contributor.authorNightingale, P
dc.contributor.authorKoutedakis, Y
dc.contributor.authorKitas, GD
dc.identifier.citationStavropoulos-Kalinoglou, A., Metsios, G.S., Panoulas, V.F. et al. (2012) Anti-tumour necrosis factor alpha therapy improves insulin sensitivity in normal-weight but not in obese patients with rheumatoid arthritis . Arthritis Research & Therapy, 14, R160 (2012).
dc.identifier.pmid22765047 (pubmed)
dc.description© 2012 The Authors. Published by BMC. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website:
dc.description.abstractIntroduction: Insulin resistance (IR), a risk factor for the development of cardiovascular disease, is common among patients with rheumatoid arthritis (RA). Inflammation, and especially tumour necrosis factor alpha (TNFα), has been associated with IR, and the administration of anti-TNFα agents is suggested to improve insulin sensitivity. However obesity, a potent contributor to IR, may limit the beneficial effects of anti-TNFα medication on IR. The aim of this study is to compare the effects of anti-TNFα therapy on IR between normal-weight and obese patients with RA.Methods: Patients who were normal-weight with IR (N+IR) or obese with IR (O+IR) and had embarked on anti-TNFα treatment, participated. Assessments included body mass index (BMI), insulin sensitivity (Homeostasis Model Assessment of insulin resistance, HOMA and the Quantitative Insulin sensitivity Check Index, QUICKI), and RA disease characteristics before and following six months of anti-TNFα treatment. Their results were compared to matched (for age, gender, BMI, disease duration and smoking status) normal-weight patients without IR (N-IR) and obese without IR (N-IR), respectively. In total, 32 patients were assessed for this study, with 8 in each group.Results: Following six months of treatment, disease activity was significantly reduced in all groups (P < 0.05) to a similar extent (P for differences between groups > 0.05 in all cases). In the total population, changes in HOMA (mean reduction at 6 m = -0.2 ± 0.1; P = 0.088) and QUICKI (mean increase at 6 m = 0.03 ± 0.022; P = 0.092) after treatment were not statistically significant, though a trend towards improvement was observed. However, N+IR patients showed a significant decrease in HOMA (mean reduction at 6 m = -0.54 ± 0.2; P = 0.002) and increase in QUICKI (mean increase at 6 m = 0.046 ± 0.02; P = 0.011). These changes were significantly different compared to the other groups (P < 0.05 in all cases). Multivariable analyses showed that the change in Erythrocyte Sedimentation Rate (ESR), and the change in C-Reactive Protein (CRP) associated with the improvement in HOMA (ESR: F 1-7 = 5.143, P = 0.019; CRP: F 1-7 = 3.122, P = 0.022) and QUICKI (ESR: F 1-7 = 3.814, P = 0.021; CRP: F 1-7 = 2.67; P = 0.041) only in the N+IR group.Conclusions: Anti-TNFα therapy, through controlling inflammation, seems to improve insulin sensitivity in normal-weight RA patients with insulin resistance, but is not sufficient to achieving the same beneficial effect in obese RA patients with insulin resistance. © 2012 Stavropoulos-Kalinoglou et al.; licensee BioMed Central Ltd.en
dc.description.sponsorshipThis study was funded by the Dudley Hospitals NHS Foundation Trust R&D Directorate. The Department of Rheumatology, Dudley Hospitals NHS Foundation Trust, has an infrastructure support grant from Arthritis Research UK (number: 17682).en
dc.publisherSpringer Science and Business Media LLCen
dc.rightsLicence for published version: Creative Commons Attribution 4.0 International
dc.subjectrheumatoid arthritisen
dc.subjectinsulin resistenceen
dc.subjectrheumatoid arthritis patienten
dc.subjectimprove insulin sensitivityen
dc.subjectbaseline body mass indexen
dc.subject.meshArthritis, Rheumatoid
dc.subject.meshInsulin Resistance
dc.subject.meshBody Weight
dc.subject.meshTumor Necrosis Factor-alpha
dc.subject.meshAntirheumatic Agents
dc.subject.meshMiddle Aged
dc.titleAnti-tumour necrosis factor alpha therapy improves insulin sensitivity in normal-weight but not in obese patients with rheumatoid arthritisen
dc.typeJournal articleen
dc.identifier.journalArthritis Research and Therapyen
rioxxterms.funderVersus Arthritisen
dc.description.versionPublished version

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Licence for published version: Creative Commons Attribution 4.0 International
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