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Seropositivity is associated with insulin resistance in patients with early inflammatory polyarthritis: results from the Norfolk Arthritis Register (NOAR): an observational study

Hoda Mirjafari1, Tracey M Farragher12, Suzanne MM Verstappen1, Allen Yates3, Diane Bunn1, Tarnya Marshall4, Mark Lunt1, Deborah PM Symmons1 and Ian N Bruce1*

Author Affiliations

1 Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, M13 9PT, UK

2 Department of Biostatistics, University of Liverpool, Brownlow Street, Liverpool, L69 3GS, UK

3 Clinical Research Department, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK

4 Norfolk Arthritis Register, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR2 3SR, UK

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Arthritis Research & Therapy 2011, 13:R159  doi:10.1186/ar3476

Published: 29 September 2011



Cardiovascular disease (CVD) is the leading cause of death in patients with inflammatory polyarthritis (IP), especially in seropositive disease. In established rheumatoid arthritis (RA), insulin resistance (IR) is increased and associated with CVD. We investigated factors associated with IR in an inception cohort of patients with early IP.


Patients with early IP (two or more swollen joints for four or more weeks), aged 18 to 65 years, seen within 24 months of symptom onset were recruited from the Norfolk Arthritis Register (NOAR), a primary-care-based inception cohort. Assessment included joint examination, current and prior therapy and completion of the Health Assessment Questionnaire. Fasting blood was taken for measurement of CVD risk factors, rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA), C-reactive protein (CRP), and insulin levels. IR was calculated using the homeostatic model assessment (HOMA-IR). We examined factors associated with IR using univariate and multivariable linear regression models.


A total of 196 patients, including 59 (30%) males, were studied with a median (interquartile range, IQR) age and IP symptom duration of 49 (40 to 57) years and 6.7 (4.6 to 10.7) months, respectively. After age and gender adjustment, HOMA-IR was associated with obesity, (β-Coefficient (95% CI); 1.60 (0.96, 2.24)), higher systolic and diastolic blood pressure (0.03 (0.01, 0.05) and 0.04 (0.01, 0.08) respectively), triglycerides (1.06 (0.54, 1.57)), and HDL (-1.38 (-2.17,-0.58)). HOMA-IR was associated with serological status and this association persisted after adjustment for classic CVD risk factors and other IP-related variables (RF β-Coefficient (95% CI); 0.87 (0.20, 1.53) and ACPA β-Coefficient (95% CI); 1.42 (0.70, 2.15)).


Seropositivity for RF or ACPA was associated with IR in this early IP cohort. This association may, in part, explain why seropositive patients have excess CVD mortality.