In my last post, I briefly discussed how various metabolic systems are involved with RA and how something called Metabolic Syndrome is more common in RA patients and is implicated in increased risk for cardiovascular disease. A recent article written by Spanish researchers (Amaro, et al., 2013) provides an excellent overview of the connection between metabolic syndrome and rheumatoid arthritis. They stated that metabolic syndrome is characterized by high blood glucose, low HDL cholesterol, high triglycerides, obesity, and hypertension. Up to 39% of RA patients display symptoms of metabolic syndrome placing them at greater risk for cardiovascular diseases. They noted that something called insulin resistance is connected with RA, increased inflammation, cardiovascular disease, and type II diabetes. According to the U.S. National Institutes of Health,
“Insulin resistance is a condition in which the body produces insulin but does not use it effectively. When people have insulin resistance, glucose builds up in the blood instead of being absorbed by the cells, leading to type 2 diabetes or prediabetes.”
A review of research conducted by European rheumatologic researchers (Amaro, et al., 2011) connected insulin resistance to RA. They revealed that insulin resistance was more common in RA patients with higher inflammatory blood markers (c-reactive protein, ESR) and disease activity measured by the DAS28. In addition to helping curb joint destruction, these researchers also noted that the use of biologics that impact inflammatory cytokines, primarily the TNF inhibitors (e.g. Humira and Remicade), may benefit those with insulin resistance. For RA patients on TNF inhibitor treatment, improvements were seen in the insulin resistance in multiple studies over the past few years. In summarizing the topic, Amaro, et al, concluded,
“The role of chronic inflammation is becoming more and more important in the development of atherosclerosis. Likewise, the latter seems increasingly important as a determinant of mortality in patients with RA. In light of the observations, there seems to be ample evidence supporting a relationship between insulin resistance, inflammation and RA, as is also the case in other chronic diseases. In addition, such insulin resistance plays an initial role in vascular damage and appears to be (along with other mechanisms such as endothelial dysfunction, cellular adhesion, etc.) a link between inflammation and atherosclerosis. For all these reasons, rheumatologists should know insulin resistance better, become familiar with its concepts, learn how to measure it, relate it to other disease parameters and consider it as a another systemic manifestation of patients with RA.”
If you have RA, it is a good idea to pay attention to metabolic systems since you are at an increased risk for insulin resistance, increased inflammation, and cardiovascular disease. Below are some strategies that will likely benefit all RA patients.
- Speak to your rheumatologist about this topic.
- Get your lipids checked out. Traditional cholesterol tests do not provide enough detailed information. It is important to know LDL levels (“bad” cholesterol), HDL levels (“good” cholesterol), triglycerides, and insulin resistance. There are newer tests like the nuclear magnetic resonance (NMR) lipoprofile test which provides detailed information about the number and type of LDL particles. It also calculates an insulin resistance score. Ask your doctor to order this test. It’s not that expensive and most insurance companies cover it.
- Watch your diet in terms of refined sugars and starches which rapidly increase blood glucose levels, cause insulin levels to spike, and add stored fat to the midsection. Such a diet increases the chances of developing insulin resistance. This is especially true for RA patients given the inflammatory connections. It is proposed that balancing low fat proteins with whole grain carbohydrates and small amounts of quality fats is the best diet for those with metabolic syndrome (see The Insulin Resistance Diet book by doctor and registered dietician Hart and Grossman for an excellent overview). In general, a low carb diet is suggested to lower levels of inflammation (see Forsythe, et al., 2008).
- Exercise if possible. You don’t need to be a long distance runner or champion body builder. It is believed that muscle resistance exercise is better for insulin resistance as it burns excess glucose in the bloodstream (see this article).