Background Objective: To find out the rate of various overweight phenotypes based on body mass index and insulin resistance (IR) in women with systemic lupus erythematosus (SLE).

Methods A total of 46 women with SLE (40[31;48] years old) without diabetes mellitus or hyperglycemia were enrolled in the study. The median SLE duration was 3,0[0,9;9,0] years, SLEDAI-2K was 5[2;8]. SLE pts were treated with glucocorticoids (GC) (83%), hydroxychloroquine (76%), immunosuppressive drugs (22%) and biological agents (11%). IR was defined as Homeostasis Model Assessment of Insulin Resistance index (HOMA-IR) ≥2,77. There were three main phenotypes of obesity/overweight: 1.’classic or metabolic unhealthy obesity/overweight’ – body mass index (BMI) ≥25kg/m2 + IR, 2.’metabolically healthy obesity/overweight ‘ – BMI ≥25kg/m2 without IR, 3.’latent or metabolic unhealthy non-obesity’ – BMI <25kg/m2 + IR.

Results The classic phenotype was found in 15%, metabolically healthy phenotype – in 28%, latent phenotype – in 7%, normal weight without metabolic disturbances – in 50% women. HOMA-IR negatively correlated with SLEDAI-2K (r= -0.35, p=0.02), and positively – with waist circumference (r=0.57, p<0.0001). Patients with normal weight without metabolic disorders were younger (p=0.02), had a lower concentration of uric acid (p=0.03) than women with the classical phenotype, received lower daily dose of GC for the entire period of SLE than these with latent phenotype (p=0.05). The healthy overweight phenotype had a higher diastolic blood pressure than patients with normal weight without IR (p=0.02), and a tendency to a greater age (p=0.06).

Conclusions A combination of BMI ≥25 kg/m2 and IR was used to separate the phenotypes of obesity/overweight, since its existence did not coincide in 35% of patients with SLE. The metabolically healthy phenotype was the most frequent, the latent phenotype was the rarest. The formation of a specific phenotype seems to be influenced by age, disease activity and the intake of GC.