In a recent study in established and treated RA patients, we found that traditional metabolic risk factors such as excess adiposity played a more prominent role in predicting skeletal muscle insulin sensitivity than systemic inflammation or other disease-related factors.[16] However, we hypothesized that the changes observed in the “lipid paradox” are less related to metabolic syndrome risk factors and more related to lack of physical activity as a result of increased disease activity, pain and inflammation. This evidence concerns the gene INS and rheumatoid arthritis.