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Anti-tumor necrosis factor-α blockade improves insulin resistance in patients with rheumatoid arthritis

M.A. Gonzalez-Gay, J.M. De Matias, C. Gonzalez-Juanatey, C. Garcia-Porrua, A. Sanchez-Andrade, J. Martin, J. Llorca


2006 Vol.24, N°1
PI 0083, PF 0086
Brief Papers

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PMID: 16539824 [PubMed]


Systemic inflammation, insulin resistance, and endothelial dysfunction have been implicated in the development of cardiovascular disease in rheumatoid arthritis (RA). Since insulin resistance can promote endothelial dysfunction and anti-TNF-α blockade yield a rapid improvement of endothelial function, we have sought to assess whether TNF-α blockade may also result in a reduction of insulin serum levels and improvement of insulin resistance in RA patients who require this therapy because of severe and refractory disease.
We recruited patients with RA seen over a period of 1 month at Hospital Xeral-Calde, Lugo, Spain, that were on treatment with anti-TNF-α monoclonal antibody-infliximab. Patients with diabetes mellitus or plasma glucose > 110 mg/dl were excluded. Fasting blood samples were taken for determination of plasma glucose and serum insulin levels immediately prior to and after infliximab infusion.
Twenty-seven RA patients (21 women; mean age: 57.1 years; mean DAS28: 4.43) fulfilled the inclusion criteria. Dramatic reduction in the serum insulin levels and insulin/glucose index was observed following infliximab infusion. Also, a significant improvement of insulin resistance and insulin sensitivity was found.
Our study confirms a rapid beneficial effect of infliximab on insulin resistance and insulin sensitivity in RA patients treated periodically with this drug. It may support the long-term use of drugs that act blocking TNF-α function to reduce the mechanisms implicated in the development of atherosclerosis in patients with RA.

Rheumatology Article