1232 - Association Between Leptin, Adiponectin and TNF-α and Response to Treatment in Patients with Rheumatoid Arthritis

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Daniel X. Xibille Friedmann1, Sara Eugenia Hernandez Gongora2, Carolina Bustos Bahena3, Liliana Dominguez Hernandez3, Ivan Martinez Rivera3, Marisol Sandoval Rios3, Jorge Eduardo Ortiz Panozo4 and Jose Luis Montiel Hernandez5, 1Hospital General de Cuernavaca, Cuernavaca Morelos, Mexico, 2Postgraduate Research Coordination, School of Medicine, Universidad Latinoamericana, Cuernavaca, México, 3Cytokines and Autoimmunity Laboratory, Faculty of Pharmacy, Universidad Autónoma del Estado de Morelos, Cuernavaca, México, Cuernavaca, Mexico, 4Center for Population Health Research. Instituto Nacional de Salud Pública, Cuernavaca, México, 5Cytokines and Autoimmunity Laboratory, Faculty of Pharmacy, Universidad Autónoma del Estado de Morelos, Cuernavaca, México
Presentation Number: 1232

Background/Purpose: Response to treatment in Rheumatoid Arthritis (RA) determines the functional prognosis in affected patients. The development of predictors of response to therapy is essential in order to adequately treat patients with RA. Leptin and Adiponectin are white fat cell derived hormones that play an immunomodulatory role in RA and their levels have been associated with clinical activity in RA.Our objective was to determine whether baseline levels of leptin, adiponectin and TNF-α predict response to treatment in patients with RA at 6 months, 1, 2, 3 and 4 years of follow-up. Method: Patients were followed at the Rheumatology outpatient clinic of the Hospital General de Cuernavaca. Patients had been diagnosed with established RA by a Rheumatologist and fulfilled the 1987 ACR classification criteria. All patients were receiving treatment with steroids and/or DMARDs, both in combination or as monotherapy, and visited the clinic every three months where physical examination and routine lab testing was performed, which included RF (nephelometry), CRP (qualitative) and ESR (Westerngren). A blood sample was taken at a baseline visit between March 2006 and December 2008 in order to determine plasma anti-CCP, leptin, adiponectin and TNF-α levels (measured using ELISA). Patient follow-up occurred on visits at 6 months and every year afterward. Descriptive statistics were employed for demographic data while linear regression and ANOVA were employed in order to determine predictors of response to treatment. Response to treatment was assessed by a change in the DAS28 score from baseline to each time point. A p-value of <0.05 was considered as statistically significant. Result: 147 patients were included of which 99 completed at least 6 months of follow up, 75 were followed for one year, 52 two years, 35 three years and 16 completed four years of follow up. All patients but 5 were women (94.9%). Mean age was 45.8 years (18-70) and mean time since onset of disease was 7.7 years (0-36). Mean body mass index was 26.95 (15-43). 92.5% of patients were RF positive and 79.7% were anti-CCP positive. Most patients received combination therapy at baseline, which included at least 2 DMARD (84.8%), the most common being methotrexate, 9.1% received methotrexate monotherapy and 6.1% received only prednisone and/or NSAIDs. No patients undergoing biologic therapy were included. Mean plasma levels for leptin were 0.27±0.8 ng/ml, for adiponectin 174.4±88.2 ng/ml, and for TNF-a 6.05±7.7 ng/ml. Higher baseline leptin levels predicted a good response to treatment at 6 months and one year (p=0.036 and 0.035, respectively), as did higher baseline TNF-α levels at one year (p=0.05). Neither leptin nor TNF-α were statistically significant predictors for long-term response to treatment (2 years and over). Higher baseline TNF-a and adiponectin levels, although not reaching statistical significance, did show a tendency to predict a poor response to treatment after 2 years (p=0.087) and 4 years (p=0.077) of follow-up, respectively. Conclusion: Baseline levels of leptin and TNF-a predict a good response to treatment in RA patients at one year , but not in the longer term.

Keywords: adipocytokines, inflammation and rheumatoid arthritis (RA)

Disclosure: D. X. Xibille Friedmann, None; S. E. Hernandez Gongora, None; C. Bustos Bahena, None; L. Dominguez Hernandez, None; I. Martinez Rivera, None; M. Sandoval Rios, None; J. E. Ortiz Panozo, None; J. L. Montiel Hernandez, None.