Poor clinical response in rheumatoid arthritis is the main risk factor for diabetes development in the short-term: A 1-year, single-centre, longitudinal study

Abstract

ObjectivesDespite of the European League Against Rheumatism (EULAR) provided different sets of recommendations for the management of cardiovascular risk in inflammatory arthritis patients, it must be pointed out that cardiometabolic comorbidity, such as type 2 diabetes (T2D), remains still underdiagnosed and undertreated in patients affected by rheumatoid arthritis (RA).MethodsIn this work, we designed a single centre, prospective study in order to better investigate the occurrence of T2D during the course of 1 year of follow-up. Furthermore, we evaluated the role of both traditional cardiovascular and RA-specific related risk factors to predict the occurrence of new T2D.ResultsIn this study, we evaluated 439 consecutive RA patients and we observed that 7.1% of our patients (31/439) developed T2D, after 12 month of prospective follow-up. The regression analysis showed that the presence of high blood pressure, the impaired fasting glucose (IFG) at the first observation and the poor EULAR-DAS28 response, after 12 months of follow–up, were significantly associated with an increased likelihood of being classified as T2D. Similarly, we observed that 7.7% of our patients (34/439) showed IFG after 12 months of prospective follow-up. The regression analysis showed that the presence of high blood pressure and the poor EULAR-DAS28 response after 12 months of follow-up, were significantly associated with an increased likelihood of showing IFG.ConclusionsOur study supports the hypothesis of a significant short-term risk of T2D in RA patients and of a close associations between uncontrolled disease activity and glucose metabolism derangement. Further multicentre, randomised-controlled studies are surely needed in order to elucidate these findings and to better ascertain the possible contribution of different therapeutic regimens to reduce this risk.

The incidence of type 2 diabetes mellitus and the traditional risk factors of carbohydrate metabolic disorders in patients with rheumatoid arthritis

“…В одном из них заболеваемость СД 2-го типа при РА составила 8,6 [10], в другом -6,3 случая на 1000 пациенто-лет [11]. В итальянском 12-месячном проспективном исследовании СД 2-го типа развился у 7,1% из 439 больных РА [12]. Стоит отметить, что во всех зарубежных когортах средний возраст больных на момент включения в исследование был на 3,5-4 года меньше, чем в представленной работе, кроме того, в анализ вошли также пациенты младше 45 лет, что, безусловно, повлияло на данный показатель.…”

Cardiovascular Safety of Anti-TNF and Non-TNF Biological Therapy in Patients with Rheumatoid Arthritis

“…The pathophysiology of endothelial dysfunction is multifactorial, a complex network of interacting factors and mechanisms being emphasized. Not only different metabolic (dyslipidemia, hyperglycemia), non-metabolic (hypertension, smoking, oxidative stress) but also RA-specific factors (systemic inflammation) are associated with vascular dysfunction [1,2,9,[15][16][17][18][19][20][21].…”

“…Regardless of substantial progresses in RA treatment, patients develop and die considerably earlier than the general population mainly related to cardiovascular comorbidities, generally in connection with accelerated atherosclerosis and cardio-metabolic complication [1,2,13,18,21].…”

“…Since broad cardio-metabolic evaluation and optimal strategies for cardiovascular risk reduction are still poorly integrated in routine practice in autoimmune conditions [13,18,21], EULAR has recently updated guidelines for cardiovascular disease risk assessment and management in systemic inflammatory conditions including RA, psoriatic arthritis, and ankylosing spondylitis [6]. An extended EULAR task force has reconsidered the old guidelines and released new overarching principles and recommendations in accordance to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement suggesting an appropriate algorithm for cardiovascular risk management in these patients [6].…”

“…RA activity and cardiovascular riskIndividual inflammatory parameters (erythrocyte sedimentation rate, ESR, and CRP), composite scores reflecting disease activity (such as disease activity score (DAS28) and clinical disease activity index (CDAI)), and disease severity (extra-articular disease) are commonly associated with cardiovascular complications in RA[1,2,[22][23][24][25][26][27][28].The link between systemic inflammation and cardiovascular outcomes persists even after adjusting according to classical risk factors (obesity, hypertension, hyperlipidemia)[1,2,[20][21][22].Thus, elevated CRP levels at the baseline and the duration of uncontrolled disease correlate with cardiovascular burden in RA[1,2,[22][23][24][25][26][27][28], while very high disease activity over time or high disease activity at RA onset also contributes to the cardiovascular risk[22,23]. Moreover, it seems that uncontrolled high disease activity promotes the highest risk of developing cardiovascular disease[1,2,[21][22][23][24][25][26][27][28]. CRP also correlated with acute myocardial infarction, one of the central complications of early accelerated atherosclerosis in RA[1,22,23].Clearly, low disease activity (DAS28 < 3.2) and remission (DAS28 < 2.6) are fundamental in preventing a 10-years risk of cardiovascular...…”