Ruscitti Piero, Ursini Francesco, Cipriani Paola, Liakouli Vasiliki, Carubbi Francesco, Berardicurti Onorina, De Sarro Giovambattista, Giacomelli Roberto
Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy.
PLoS One. 2017 Jul 12;12(7):e0181203. doi: 10.1371/journal.pone.0181203. eCollection 2017.
Despite 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).
In 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.
In 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.
Our 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.
尽管欧洲抗风湿病联盟（EULAR）针对炎症性关节炎患者的心血管风险管理提供了不同的建议，但必须指出，在类风湿关节炎（RA）患者中，2型糖尿病（T2D）等心血管代谢合并症仍未得到充分诊断和治疗。
在这项研究中，我们设计了一项单中心前瞻性研究，以更好地调查随访1年期间T2D的发生情况。此外，我们评估了传统心血管危险因素和RA特异性相关危险因素在预测新发T2D中的作用。
在本研究中，我们评估了439例连续的RA患者，前瞻性随访12个月后，我们观察到7.1%的患者（31/439）发生了T2D。回归分析表明，高血压的存在、首次观察时的空腹血糖受损（IFG）以及随访12个月后EULAR-DAS28反应不佳，与被归类为T2D的可能性增加显著相关。同样，前瞻性随访12个月后，我们观察到7.7%的患者（34/439）出现了IFG。回归分析表明，高血压的存在以及随访12个月后EULAR-DAS28反应不佳，与出现IFG的可能性增加显著相关。
我们的研究支持RA患者存在T2D短期显著风险以及疾病活动未得到控制与糖代谢紊乱密切相关的假设。为了阐明这些发现并更好地确定不同治疗方案对降低这种风险的可能作用，肯定需要进一步的多中心随机对照研究。
