RESEARCH - Steroids and insulin sensitivity in RA

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J Rheumatol. 2004 May;31(5):867-74.

Glucocorticoids and insulin sensitivity in rheumatoid arthritis.

Dessein PH, Joffe BI, Stanwix AE, Christian BF, Veller M.

Department of Rheumatology, Johannesburg Hospital, Johannesburg, South

Africa. Dessein@...

OBJECTIVE: To evaluate the effects of glucocorticoids on cardiovascular (CV)

risk in rheumatoid arthritis (RA). METHODS: We recorded demographic,

clinical, disease outcome, and treatment variables in 92 consecutive RA

patients who were not taking lipid-lowering or antidiabetic medications.

Fasting blood tests were taken for determination of lipids, ultra sensitive

C-reactive protein (CRP), rheumatoid factor, insulin, and glucose. Insulin

sensitivity was determined using the Quantitative Insulin Sensitivity Check

Index (QUICKI). RESULTS: Seventy-four (80%) patients were women, 80

Caucasian, 9 Asian, 2 of mixed ancestry and 1 Black. Their mean (95%

confidence interval, CI) age, disease duration, and followup duration at our

clinic were 56 (54-58), 11 (9-13) and 6 (5-6) years, respectively.

Thirty-seven (40%) patients had received oral prednisone [cumulative dose

4.8 (2.0-8.5) g; duration one month to 20 years], and all patients had

received pulsed (intraarticular, intramuscular, and/or intravenous)

methylprednisolone [cumulative dose 2.0 (1.6-2.6) g]. Glucocorticoids were

not associated with obesity, hypertension, or dyslipidemia. Having taken

prednisone and high yearly frequencies of pulsed glucocorticoid

administrations were associated with decreased insulin sensitivity (p <

0.05). After controlling for body mass index, ever having taken prednisone

and high doses of pulsed glucocorticoids were independently associated with

decreased insulin sensitivity (p < 0.05).

CONCLUSION: Previous exposure to oral prednisone and high doses of pulsed

glucocorticoids were associated with decreased insulin sensitivity in RA.

Since decreased insulin sensitivity is an independent risk factor for CV

disease, glucocorticoids may contribute to the excess CV event rates in RA.

PMID: 15124244

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15124244 & itool=iconabstr

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