Metrnl: A predictive marker of atherosclerosis among Rheumatoid Arthritis patients

Metrnl is a novel secreted protein exerting pleiotropic effects on inflammation and metabolism. Metrnl is increased in rheumatoid arthritis patients, however, Metrnl deficiency causes endothelial dysfunction which in turn promotes atherosclerosis. This study aimed to analyze serum Metrnl in Rheumatoid Arthritis patients with and without atherosclerosis. A case-control study was conducted on 50 Rheumatoid patients compared with 50 sex and age-matched control group. Metrnl levels were measured in blood samples from patients and controls by Enzyme-linked immunosorbent assay (ELISA), and CIMT was measured using Doppler ultrasonography. Medical data were collected regarding the patients’ clinical manifestations, comorbidities, and treatments. The disease activity score-28 (DAS28) was used to evaluate the disease activity of RA. Metrnl, right, and left CIMT showed a significant increase in the RA group when compared to the control group. Metrnl level showed a significant negative correlation with CRP, cholesterol, right CIMT, and left CIMT. However, no significant correlation was found between Metrnl and other parameters. At a cut-off point, ≥1.0748 Metrnl level showed significant AUC with 65% specificity and 76% sensitivity. At cut-off point ≥ 0.55, right and left CIMT levels showed significant AUC with 82% specificity and 48% sensitivity for differentiation between cases and controls. Age, BMI, disease duration, Family history of premature atherosclerosis, CRP, ESR, TG, cholesterol level, LDL, HDL, and lower Metrnl were associated with increasing CIMT in rheumatoid patients in univariate analysis. However, in multivariate analysis, only age, ESR, TG, HDL, and Metrnl were associated with increasing CIMT in rheumatoid patients. In Conclusion: Metrnl increased in patients with RA while lower Metrnl levels were correlated with increased CIMT in cases. Age, BMI, disease duration, Family history of premature atherosclerosis, CRP, ESR, TG, cholesterol level, and LDL, were linked to an increase in CIMT in rheumatoid patients