Raili Müller „​Cardiometabolic risk profile and body composition in early rheumatoid arthritis“ | University of Tartu

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Contacts of UT units

Faculty of Arts and Humanities
Faculty phone: 
+372 737 5341
Faculty address: 
Jakobi 2, rooms 116–121, 51005 Tartu
  • Dean's Office
    Faculty phone: 
    + 372 737 5341
    Faculty address: 
    Jakobi 2, rooms 116–121, 51005 Tartu
  • Institute of History and Archaeology
    Faculty phone: 
    +372 737 5651
    Faculty address: 
    Jakobi 2, 51005 Tartu
  • Institute of Estonian and General Linguistics
    Faculty phone: 
    +372 737 5221
    Faculty address: 
    Jakobi 2, 51005 Tartu
  • Institute of Philosophy and Semiotics
    Faculty phone: 
    +372 737 5314
    Faculty address: 
    Jakobi 2, rooms 309–352, 51005 Tartu
  • Institute of Cultural Research
    Faculty phone: 
    (+372) 737 5223
    Faculty address: 
    Ülikooli 16, 51003 Tartu
  • School of Theology and Religious Studies
    Faculty phone: 
    +372 737 5301
    Faculty address: 
    Ülikooli 18–310, 50090 Tartu
  • College of Foreign Languages and Cultures
    Faculty address: 
    Lossi 3, 51003 Tartu
  • Viljandi Culture Academy
    Faculty phone: 
    +372 435 5232
    Faculty address: 
    Posti 1, 71004 Viljandi
Faculty of Social Sciences
Faculty phone: 
+372 737 5957
Faculty address: 
Lossi 36, 51003 Tartu
  • Dean's Office
    Faculty phone: 
    + 372 737 5900
    Faculty address: 
    Lossi 36, 51003 Tartu
  • Institute of Education
    Faculty phone: 
    +372 737 6440
    Faculty address: 
    Salme 1a–29, 50103 Tartu
  • Johan Skytte Institute of Political Studies
    Faculty phone: 
    +372 737 5582
    Faculty address: 
    Lossi 36–301, 51003 Tartu
  • School of Economics and Business Administration
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    +372 737 6310
    Faculty address: 
    Narva mnt 18, 51009 Tartu
  • Institute of Psychology
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    Faculty address: 
    Näituse 2, 50409 Tartu
  • School of Law
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    Faculty address: 
    Näituse 20–324, 50409 Tartu
  • Institute of Social Studies
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    Lossi 36, 51003 Tartu
  • Narva College
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    Raekoja plats 2, 20307 Narva
  • Pärnu College
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    Ringi 35, 80012 Pärnu
Faculty of Medicine
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+372 737 5326
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Ravila 19, 50411 Tartu
  • Dean's Office
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    Faculty address: 
    Ravila 19, 50411 Tartu
  • Institute of Biomedicine and Translational Medicine
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    Faculty address: 
    Biomeedikum, Ravila 19, 50411 Tartu
  • Institute of Pharmacy
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    Nooruse 1, 50411 Tartu
  • Institute of Dentistry
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    Raekoja plats 6, 51003 Tartu
  • Institute of Clinical Medicine
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    Faculty address: 
    L. Puusepa 8, 50406 Tartu
  • Institute of Family Medicine and Public Health
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    +372 737 4190
    Faculty address: 
    Ravila 19, 50411 Tartu
  • Institute of Sport Sciences and Physiotherapy
    Faculty phone: 
    +372 737 5360
    Faculty address: 
    Jakobi 5–205, 51005 Tartu
Faculty of Science and Technology
Faculty phone: 
+372 737 5820
Faculty address: 
Vanemuise 46–208, 51014 Tartu
  • Dean's Office
    Faculty phone: 
    +372 737 5820
    Faculty address: 
    Vanemuise 46–208, 51005 Tartu
  • Institute of Computer Science
    Faculty phone: 
    +372 737 5445
    Faculty address: 
    Narva mnt 18, 51009 Tartu
  • Estonian Marine Institute
    Faculty phone: 
    +372 671 8902
    Faculty address: 
    Mäealuse 14, 12618 Tallinn
  • Institute of Physics
    Faculty address: 
    W. Ostwaldi 1, 50411 Tartu
  • Institute of Chemistry
    Faculty phone: 
    +372 737 5261
    Faculty address: 
    Ravila 14a, 50411 Tartu
  • Institute of Mathematics and Statistics
    Faculty phone: 
    +372 737 5860
    Faculty address: 
    Narva mnt 18, 51009 Tartu
  • Institute of Molecular and Cell Biology
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    Faculty address: 
    Riia 23, 23b–134, 51010 Tartu
  • Tartu Observatory
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    Faculty address: 
    Observatooriumi 1, Tõravere, 61602 Tartumaa
  • Institute of Technology
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    Faculty address: 
    Nooruse 1, 50411 Tartu
  • Institute of Ecology and Earth Sciences
    Faculty phone: 
    +372 737 5835
    Faculty address: 
    Vanemuise 46, 51003 Tartu
Institutions
  • Library
    Faculty phone: 
    +372 737 5702
    Faculty address: 
    W. Struve 1, 50091 Tartu
  • Youth Academy
    Faculty phone: 
    +372 737 5581
    Faculty address: 
    Uppsala 10, 51003 Tartu
  • Institute of Genomics
    Faculty phone: 
    +372 737 4000
    Faculty address: 
    Riia 23b, 51010 Tartu
  • Museum
    Faculty phone: 
    +372 737 5674
    Faculty address: 
    Lossi 25, 51003 Tartu
  • University of Tartu Natural History Museum and Botanical Garden
    Faculty phone: 
    +372 737 6076
    Faculty address: 
    Vanemuise 46, 51003 Tartu
Support Units
  • Administrative Office
    Faculty phone: 
    +372 737 5606
    Faculty address: 
    Ülikooli 18a, 51005 Tartu
  • Centre for Entrepreneurship and Innovation
    Faculty phone: 
    +372 737 6339
    Faculty address: 
    Lossi 3, III floor, 51003 Tartu
  • University Office in Tallinn
    Faculty phone: 
    +372 737 6600
    Faculty address: 
    Teatri väljak 3, 10143 Tallinn
  • Estates Office
    Faculty phone: 
    +372 737 5137
    Faculty address: 
    Ülikooli 18a, 51005 Tartu
  • Finance Office
    Faculty phone: 
    +372 737 5125
    Faculty address: 
    Jakobi 4, 51005 Tartu
  • Grant Office
    Faculty phone: 
    +372 737 6215
    Faculty address: 
    Lossi 3, III floor, 51003 Tartu
  • Information Technology Office
    Faculty phone: 
    +372 737 6000, IT-help: +372 737 5500
    Faculty address: 
    Ülikooli 18a, 51005 Tartu
  • Human Resources Office
    Faculty phone: 
    +372 737 5145
    Faculty address: 
    Ülikooli 18, rooms 302 and 304, 50090 Tartu
  • Internal Audit Office
    Faculty address: 
    Ülikooli 18-244, 51005 Tartu
  • Marketing and Communication Office
    Faculty phone: 
    +372 737 5687
    Faculty address: 
    Ülikooli 18, rooms 102, 104, 209, 210, 50090 Tartu
  • Office of Academic Affairs
    Faculty phone: 
    +372 737 5620
    Faculty address: 
    Ülikooli 18, 50090 Tartu
  • Procurement Office
    Faculty phone: 
    +372 737 6632
    Faculty address: 
    Ülikooli 18a, 51005 Tartu
  • Rector's Strategy Office
    Faculty phone: 
    +372 737 5600
    Faculty address: 
    Ülikooli 18, 50090 Tartu
  • Student Council
    Faculty address: 
    Ülikooli 18b, 51005 Tartu
  • University of Tartu Press
    Faculty phone: 
    +372 737 5945
    Faculty address: 
    W. Struve 1, 50091 Tartu
Other Units
  • University of Tartu Academic Sports Club
    Faculty phone: 
    +372 737 5371
    Faculty address: 
    Ujula 4, 51008 Tartu
  • Tartu Student Village
    Faculty phone: 
    +372 740 9959
    Faculty address: 
    Narva mnt 25, 51013 Tartu
  • Tartu Students’ Club
    Faculty phone: 
    +372 730 2400
    Faculty address: 
    Kalevi 24, 51010 Tartu
  • Tartu University Hospital
    Faculty address: 
    L. Puusepa 1a, 50406 Tartu
  • University of Tartu Foundation
    Faculty phone: 
    +372 737 5852
    Faculty address: 
    Ülikooli 18, 50090 Tartu
  • View all other units

Raili Müller „​Cardiometabolic risk profile and body composition in early rheumatoid arthritis“

Date: 
15.06.2020 - 14:00

On 15 June at 14:00 will Raili Müller defend her doctoral thesis „Cardiometabolic risk profile and body composition in early rheumatoid arthritis“.

Supervisors:
Senior Research Fellow in Rheumatology Riina Kallikorm cand (Medicine), Institute of Clinical Medicine, Unversity of Tartu
Professor of Propaedeutics of Internal Medicine Margus Lember (dr. med., Institute of Clinical Medicine, Unversity of Tartu
Senior Research Fellow in Internal Medicine Kaja Põlluste (PhD (Public Health), Institute of Clinical Medicine, Unversity of Tartu

Opponent:
Markku Jaakko Kauppi (PhD), University of Helsinki, Finland

Summary
Rheumatoid arthritis is a chronic progressive autoimmune disease that affects about 1% of population. The inflammatory process begins long time before the onset of symptoms of arthritis, damage to joints is only a tip of the iceberg, systemic inflammation has an effect on the whole body. Joint deformations and specific damage to internal organs is preventable with adequate treatment but people suffering from the disease are still at elevated risk of having cardiovascular disease and premature death as a consequence due to reasons not completely understood.

In general population increased risk of cardiovascular disease is associated with overweight and obesity, in rheumatoid arthritis the opposite is evident- patients with higher body mass are at lower risk of getting heart disease.

Obesity induced elevated cardiovascular risk is associated with metabolic disturbances. The co- occurrence of hypertension, diabetes, high cholesterol and triglyceride levels and abdominal obesity is called metabolic syndrome. The syndrome is associated with another important metabolic alteration called insulin resistance that presents as low sensitivity in muscle, fat and liver cells to insulin- a hormone responsible for regulation of blood sugar.

In established rheumatoid arthritis a change in body composition called sarcopenic obesity (high fat percentage and low proportion of muscle tissue) has been described. This phenomenon increases the risk of cardiovascular disease at a higher extent than regular obesity. A change in body composition can be one of the reasons behind increased risk for heart disease in rheumatoid arthritis, metabolic disturbances caused by altered body composition can remain undetected on routine evaluation.

Most of the previous studies looking into metabolic risk factors and body composition in rheumatoid arthritis have focused on data of patients with long disease duration. Some authors have hypothesized that the change in body composition may already start in the early or even preclinical stage of the disease.

This study investigated the presence of metabolic syndrome, insulin resistance and changes in body composition in early rheumatoid arthritis. Additionally, we tried to find lifestyle and disease- associated factors explaining the development of body composition alterations.

This project is based on a study of 92 patients with early rheumatoid arthritis with an average time from diagnosis one month. The data was compared to Estonian general population using patients from family doctors practice lists as control subjects.

We found that metabolic factors associated with elevated cardiovascular risk can be detected in patients with rheumatoid arthritis in the first months after the disease onset. Normal weight patients with rheumatoid arthritis had hypertension, hyperglycemia and metabolic syndrome significantly more often than the control subjects with similar weight status, 17% of arthritis patients with normal weight had metabolic syndrome and only 2% of the controls. There was no difference between the groups in the presence of assessed cardiovascular risk factors or metabolic syndrome among overweight/obese subjects. Having rheumatoid arthritis was associated with higher blood pressure but only 31% of the rheumatoid patients with hypertension used anti-hypertensive medications, at the same time more than 50% of control subjects with hypertension received treatment.

Low sensitivity to insulin was almost 5 times more common among arthritis patients. Insulin resistance was present more often in men and patients with high inflammatory markers. We found that insulin sensitivity could not be predicted by body mass index, reduced insulin sensitivity in rheumatoid arthritis group was associated with low lean mass.

There was a significant difference in body fat and muscle composition between control subjects and early rheumatoid arthritis group. 42% of patients with arthritis had low muscle mass, 68% had high body fat percentage and 26% had both reduced muscle mass and excess fat (sarcopenic obesity). Only 16% of the patients did not have any abnormal components of body composition, at the same time 43% of the control subjects had healthy body composition with both normal fat percentage and muscle mass. Looking into the factors associated with low muscle mass we found a difference between rheumatoid arthritis and control group. In arthritis group low lean mass was associated with higher levels of inflammatory markers, glucocorticosteroid therapy and reduced protein intake in diet. In the control group the most important factors were older age, inactivity and smoking.

Results of the study show that all patients with early rheumatoid arthritis should be screened for risk factors of cardiovascular disease regardless of their weight status. The development of metabolic risk factors in rheumatoid arthritis is independent of body weight and can appear in the initial stage of the disease. These differences should be taken into account when evaluating cardiovascular risk in patients with rheumatoid arthritis. Timely screening and treatment could postpone the progression of cardiovascular disease and avoid premature death.

Location: 
Ravila 19-1006 or video bridge
Event category: