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The aim of this study was to evaluate the involvement of TNF-α and insulin resistance (IR) in the inflammatory process, oxidative stress, and disease activity in patients with rheumatoid arthritis (RA). This cross-sectional study included 270 subjects (control group, n = 97 ) and RA patients ( n = 173 ). RA patients were divided into four groups: the first group without IR and not using antitumor necrosis factor-α ( T N F - ) (G1, IR− TNF−); the second group without IR and using anti-TNF-α (G2, I R - TNF+); the third group with IR and not using anti-TNF-α (G3, IR+ T N F - ); and the fourth group with IR and using anti-TNF-α (G4, IR+ TNF+). G3 and G4 had higher ( p < 0.05 ) advanced oxidation protein products (AOPPs) and oxidative stress index (OSI) compared to G1. G4 group presented higher ( p < 0.05 ) AOPPs and OSI than G2. TRAP was significantly lower in G3 compared to G1. Plasma TNF-α levels were significantly higher in G4 and G2 compared to G1 ( p < 0.0001 ) and G3 ( p < 0.0001 and p < 0.01 , resp.). The presence of insulin resistance was robustly associated with both oxidative stress and TNF-α levels. More studies are warranted to verify if IR can be involved in therapeutic failure with TNF-α inhibitors. This trial is registered with Brazilian Clinical Trials Registry Register number RBR-2jvj92.

Influence of Insulin Resistance and TNF-α on the Inflammatory Process, Oxidative Stress, and Disease Activity in Patients with Rheumatoid Arthritis