Gorica Ristić

Research cannot stop because the disease does not stop!

Associate Professor Gorica G. Ristić, MD, PhD, is Head of Rheumatology ward 2 of the Department of Rheumatology and Clinical Immunology, Military Medical Academy in Belgrade in Serbia. She is honoured and sincerely grateful to be this year’s finalist in the field of Rheumatology, especially because the research will be widely visible for the international scientific community in this way.

For almost twenty years of her professional career she has been profoundly involved in the diagnosis and management of most challenging patients with rheumatoid arthritis (RA). Her clinical research was mainly focused on increased incidence of cardiovascular diseases in these patients due to accelerated atherosclerosis. In the last years, her clinical research was expanded to the role of chronic inflammation on glucose metabolism and subsequently on accelerated atherosclerosis. In her study, impact of disease activity on impaired glucose metabolism in RA patients, was explored. 

The influence of classic insulin resistance-related risk factors (age, lipids, obesity, and hypertension), inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), and rheumatoid arthritis itself on glucose metabolism were analyzed. 

Significantly increased insulin resistance and decreased insulin sensitivity in RA patients compared to healthy controls was revealed and diseases activity was an independent risk factor for this altered metabolic state. The presence of high disease activity was the main contributor to the prediction of this metabolic disturbance, outweighing the impact of classic insulin resistance-related risk factors. These results reinforce the importance of RA itself in the pathophysiology of impaired glucose metabolism. Their original contribution in this field was the detection of the impact of Matrix metalloproteinase-3, as the more reliable marker of RA activity, on this metabolic dysfunction. 

Prof. Ristić and her team also revealed impaired β-cell function in RA patients through inadequate augmentation of insulin release in response to decreased insulin sensitivity compared to healthy controls, and through significantly higher intact proinsulin, a direct marker of β-cell dysfunction. 

The potential contribution of our results for clinical practice is to raise awareness of the importance of controlling disease activity not only to prevent the progression of RA itself but also impaired glucose metabolism. That is the best way to decrease the risk for cardiovascular diseases in patients with RA.

Although devoted to her clinical duties, her students, and research, Prof. Ristić tries to enjoy as much of her free time with her husband and son by travelling to the seaside whenever possible, going to the theatre, and riding the bike.