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Issue 210 Item 15 Glucocorticoids Decrease Insulin Sensitivity in RA Patients

Insulin resistance occurs in 80% of patients with rheumatoid arthritis. "All RA patients should be studied for the presence of insulin resistance, since it is an independent predictor of cardiovascular disease and it occurred in nearly 80% of RA patients…in the current study," Dr. Patrick H. Dessein from University of the Witwatersrand, Johannesburg, South Africa stated.

Dr. Dessein and colleagues hypothesized that glucocorticoids contribute to traditional cardiovascular risk factors in RA patients, who have an increased risk of cardiovascular disease. They tested their hypothesis by evaluating 92 RA patients who were not taking lipid-lowering or antidiabetic medications.

Seventy-two (78%) of the patients had decreased insulin sensitivity, the authors report, and 12 of these had type 2 diabetes mellitus. Mean fasting insulin levels were significantly higher in RA patients, whether or not they had received oral glucocorticoids, than in control subjects, the report indicates.

Ever having taken prednisone and high annual frequencies of pulsed glucocorticoid treatments were independently associated with decreased insulin sensitivity, the researchers note, but other glucocorticoid therapy characteristics were not independently associated with insulin sensitivity.

In contrast, the investigators report, none of the glucocorticoid therapy characteristics were associated with cardiovascular risk factors that included elevated body-mass index, hypertension, abnormal lipid levels or elevated triglyceride levels.

"Glucocorticoids should be used sparingly and preferably administered as bridge therapy with use of intraarticular administration using low quantities rather than as ongoing therapy," Dr. Dessein said.
J Rheumatol 2004;31:867-874.