Higher disease activity increases diabetes risk in Rheumatoid Arthritis: BMJ

Higher disease activity and cytokine/chemokine levels are linked to an increased incidence of incident diabetes mellitus (DM) in Rheumatoid Arthritis (RA) patients, says an article published in Annals of the Rheumatic Diseases.

This study was conducted by Joshua Baker and team with the objective to look for links between inflammatory disease activity (including the measurement of particular cytokines and chemokines) and incident diabetes.

Participants in this trial were people with physician-confirmed RA from the Veteran's Affairs Rheumatoid Arthritis Registry. Disease activity and clinical evaluations take place throughout time as part of clinical treatment. Thirty chemokines and cytokines were evaluated in banked serum acquired during enrollment. The cytokine/chemokine concentrations were log-adjusted and standardized (per SD). The definition of incident DM was based on established algorithms that used diagnostic codes and medicines. Multivariable Cox proportional hazard models were used to examine the relationships between clinical variables and incident diabetes. Independent correlations between cytokines/chemokines and incident diabetes were investigated after controlling for age, gender, race, smoking, BMI, and medication usage at baseline.

The results of this study stated as follow:

1. Over 9223 person-years of follow-up, there were 130 incident cases among 1866 individuals with RA who did not have prevalent diabetes at the time of enrollment.

2. High Disease Activity Score (DAS28)-C reactive protein (CRP), obese BMI, older age, and male sex were linked to an increased risk of incident DM, but current smoking and methotrexate usage were linked to a lower risk.

3. Patients who took methotrexate had a decreased risk.

4. Several cytokines/chemokines, including interleukin(IL)-1, IL-6, and select macrophage-derived cytokines/chemokines (HR range 1.11–1.26), were shown to be independently related (per 1 SD) with DM incidence.

5. These relationships were not caused by the DAS28-CRP.

In conclusion, these findings indicate paying more attention to the risk of diabetes in patients with increased disease activity, as well as more active therapy to lower the risk.

Reference:

Baker JF, England BR, George M, et al. Disease activity, cytokines, chemokines and the risk of incident diabetes in rheumatoid arthritis, Annals of the Rheumatic Diseases 2021;80:566-572. doi:10.1136/annrheumdis-2020-219140

Keywords: cytokines, chemokines, diabetes, rheumatoid arthritis, interleukin, inflammation, body mass index, obesity, British Medical Journal,