Visfatin in Systemic Lupus Erythematosus Patients: An immune-Metabolic Interplay

Abstract

This study was done to assess the possible effects of obesity on SLE disease process, activity and course and to measure the serum visfatin levels in obese and non-obese SLE patients, its clinical relevance to disease activity and insulin resistance in SLE patients. The study was performed on sixty (60) SLE patients satisfying the 1987 American College of Rheumatology revised classification criteria (ACR) (Hochberg, 1997). They were classified according to BMI into: 30 non-obese SLE patients (BMI: 18.5- 24.9) and 30 obese SLE patients (BMI ≥30). In addition to 60 apparently normal volunteer individuals (30 obese and 30 non obese) with matched age and sex as control groups. All patients were subjected to detailed medical history, full clinical examination, measurement of BMI, waist circumference, hip circumference, calculation of waist/ hip ratio, assessment of SLE disease activity using BILAG-2004 index and laboratory investigations (CBC, ESR, fasting blood glucose, renal function tests, liver function tests, lipids profile, fasting plasma insulin, calculation of insulin resistance by HOMA score). Assay of serum visfatin level by ELISA kits. We have found that; 40.0% of obese lupus patients were hypertensive, while only 16.6% of non-obese SLE patients were hypertensive, this was statistically significant. Diastolic blood pressure was significantly higher in obese lupus patients when compared to non-obese patients. There were statistically significant higher grades of cardiorespiratory manifestations of BILAG score in obese SLE patients when compared to non-obese patients. There were statistically significant higher levels of total serum cholesterol; serum triglyceride and lower HDL level in obese SLE patients when compared to obese controls (matched BMI). The same observations were recorded on comparing non-obese SLE patients to non-obese controls (matched BMI). Moreover, we found statistically significant higher levels of fasting serum insulin, insulin resistance and higher prevalence of metabolic syndrome among obese SLE patients when compared to obese controls and statistically significant higher prevalence of insulin resistance and metabolic syndrome in non-obese SLE patients when compared to non-obese controls. We found significantly higher serum total cholesterol, triglycerides, fasting blood glucose and fasting serum insulin in obese SLE patients when compared to non- obese SLE. In this study, we have found that 60% of obese SLE patients has metabolic syndrome while only 20% of non-obese SLE patients has metabolic syndrome and this difference was statistically significant.