Geisinger Health System, Danville, PA, USA.
J Clin Rheumatol. 2011 Apr;17(3):115-20. doi: 10.1097/RHU.0b013e318214b6b5.
BACKGROUND/OBJECTIVES: Several studies have associated hydroxychloroquine use with decreased risk of diabetes mellitus (diabetes) or improved glycemic control in rheumatoid arthritis patients, but the studies were small or used data from self-report. The present study sought to replicate this protective relationship in a health system using electronic health records with laboratory data and physician diagnoses.
This study is a retrospective cohort of 1127 adults with newly diagnosed rheumatoid arthritis and no diabetes within the Geisinger Health System between January 1, 2003, and March 31, 2008. Patients were classified as ever users (n = 333) or never users (n = 794) of hydroxychloroquine. Incident diabetes cases were defined using 2010 American Diabetes Association criteria.
The median follow-up times for the ever and never hydroxychloroquine users were 26.0 and 23.0 months, respectively (P = 0.28). The median duration of hydroxychloroquine exposure was 14.0 months. Of the 48 cases developing diabetes during observation, 3 were exposed to hydroxychloroquine at time of development and 45 were nonexposed, yielding incidence rates of 6.2 and 22.0 per 1000 per year (P = 0.03), respectively. In time-varying Cox proportional hazards regression models adjusting for sex, age, body mass index, positive rheumatoid factor and anti-cyclic citrullinated peptide antibodies, erythrocyte sedimentation rate, and nonsteroidal anti-inflammatory drug, glucocorticoid, methotrexate, and tumor necrosis factor α inhibitor use, the hazard ratio for incident diabetes among hydroxychloroquine users was 0.29 (95% confidence interval, 0.09-0.95; P = 0.04) compared with nonusers.
Our findings support the potential benefit of hydroxychloroquine in attenuating the risk of diabetes in rheumatoid arthritis patients. Further work is needed to determine its potential preventive role in other groups at high risk for diabetes.
背景/目的：几项研究表明，羟氯喹的使用与类风湿关节炎患者糖尿病（糖尿病）风险降低或血糖控制改善相关，但这些研究规模较小或使用了自我报告的数据。本研究旨在通过使用电子健康记录和实验室数据及医生诊断的健康系统复制这种保护关系。
这是一项回顾性队列研究，纳入了 2003 年 1 月 1 日至 2008 年 3 月 31 日期间在 Geisinger 健康系统中诊断为类风湿关节炎且无糖尿病的 1127 名成年人。患者分为羟氯喹既往使用者（n=333）和未使用者（n=794）。根据 2010 年美国糖尿病协会标准定义新发糖尿病病例。
羟氯喹既往使用者和未使用者的中位随访时间分别为 26.0 和 23.0 个月（P=0.28）。羟氯喹暴露的中位时间为 14.0 个月。在观察期间，48 例发生糖尿病，其中 3 例在发病时暴露于羟氯喹，45 例未暴露，发病率分别为 6.2 和 22.0/1000 人年（P=0.03）。在调整性别、年龄、体重指数、阳性类风湿因子和抗环瓜氨酸肽抗体、红细胞沉降率、非甾体抗炎药、糖皮质激素、甲氨蝶呤和肿瘤坏死因子α抑制剂使用的时变 Cox 比例风险回归模型中，羟氯喹使用者发生糖尿病的风险比为 0.29（95%置信区间，0.09-0.95；P=0.04），而非使用者为 0.29（95%置信区间，0.09-0.95；P=0.04）。
我们的发现支持羟氯喹在减轻类风湿关节炎患者糖尿病风险方面的潜在益处。需要进一步的工作来确定其在其他糖尿病高危人群中的潜在预防作用。
