Influence of Insulin Resistance and TNF-αon the Inflammatory Process, Oxidative Stress, and Disease Activity in Patients with Rheumatoid Arthritis
The aim of this study was to evaluate the involvement of TNF-αand insulin resistance (IR) in the inflammatory process, oxidative stress, and disease activity in patients with rheumatoid arthritis (RA). This cross-sectional study included 270 subjects (control group,n=97) and RA patients (n=173). RA patients were divided into four groups: the first group without IR and not using antitumor necrosis factor-α(TNF-) (G1, IR− TNF−); the second group without IR and using anti-TNF-α(G2,IR-TNF+); the third group with IR and not using anti-TNF-α(G3, IR+TNF-); and the fourth group with IR and using anti-TNF-α(G4, IR+ TNF+). G3 and G4 had higher (p<0.05) advanced oxidation protein products (AOPPs) and oxidative stress index (OSI) compared to G1. G4 group presented higher (p<0.05) AOPPs and OSI than G2. TRAP was significantly lower in G3 compared to G1. Plasma TNF-αlevels were significantly higher in G4 and G2 compared to G1 (p<0.0001) and G3 (p<0.0001andp<0.01, resp.). The presence of insulin resistance was robustly associated with both oxidative stress and TNF-αlevels. More studies are warranted to verify if IR can be involved in therapeutic failure with TNF-αinhibitors. This trial is registered with Brazilian Clinical Trials Registry Register numberRBR-2jvj92.