title: Diabetes mellitus and insulin resistance in patients with rheumatoid arthritis: risk reduction in a chronic inflammatory disease.
abstract: OBJECTIVE
  To perform a systematic literature review of the potential association among molecular markers of inflammation, alterations in body composition, and insulin resistance (IR), a precursor to type 2 diabetes mellitus (DM), in rheumatoid arthritis (RA) patients. To determine the impact of tumor necrosis factor α (TNFα) as a pivotal proinflammatory cytokine in the pathophysiology of type 2 DM and RA, and the effect of antirheumatic drugs on glycemic control.
  
  
  METHODS
  We performed a search of PubMed to identify articles on IR and body habitus in patients with RA.
  
  
  RESULTS
  Patients with RA had characteristics placing them at high risk for IR and type 2 DM. The incidence and prevalence of type 2 DM in RA was not clearly increased compared with the general population; however, studies suggested that patients with RA are likely to have IR and have increased risk of cardiovascular disease (CVD). The prevalence of type 2 DM and IR could be estimated from reports of risk factors for CVD in RA patients. The TNFα antagonists provided rapid and effective control of RA-related inflammation. Evidence indicated that extended use of TNFα antagonists in RA may provide the additional benefit of improving insulin sensitivity. These treatment-related changes may contribute to an overall reduction in the risk of type 2 DM and CVD in RA patients.
  
  
  CONCLUSIONS
  Controlling inflammation may improve insulin sensitivity and subsequently reduce the risk of developing type 2 DM in RA patients. This may also reduce the risk of CVD in this high-risk group. Future studies are required to elucidate the relationships between inflammation, body composition, IR, TNFα antagonist use, and the risk of developing type 2 DM in RA patients.
authors: University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania 15261, USA. wasko@pitt.edu
authors: Mary Chester
authors: MC
authors: Wasko
authors: Jonathan
authors: J
authors: Kay
authors: Elizabeth C
authors: EC
authors: Hsia
authors: Mahboob U
authors: MU
authors: Rahman
mesh_terms: D000818:Animals; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications / Q000517:prevention & control*; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood / Q000502:physiology*; D007333:Insulin Resistance / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic; D040242:Risk Reduction Behavior
chemical_list: D018836:Inflammation Mediators