Ruscitti Piero, Ursini Francesco, Cipriani Paola, Ciccia Francesco, Liakouli Vasiliki, Carubbi Francesco, Guggino Giuliana, Berardicurti Onorina, Grembiale Rosadaniela, Triolo Giovanni, De Sarro Giovambattista, Giacomelli Roberto
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy.
Medicine (Baltimore). 2017 Aug;96(34):e7896. doi: 10.1097/MD.0000000000007896.
Although the better management of rheumatoid arthritis (RA) has significantly improved the long-term outcome of affected patients, a significant proportion of these may develop associated comorbidities including cardiometabolic complications. However, it must be pointed out that a comprehensive cardiometabolic evaluation is still poorly integrated into the management of RA patients, due to a limited awareness of the problem, a lack of appropriate clinical studies, and optimal strategies for cardiovascular (CV) risk reduction in RA. In addition, although several studies investigated the possible association between traditional CV risk factors and RA, conflicting results are still available.On this basis, we planned this cross-sectional study, aimed at investigating the prevalence of type 2 diabetes (T2D) and impaired fasting glucose (IFG) in RA patients compared with age- and gender- matched control individuals. Furthermore, we analyzed the role of both traditional and RA-related CV risk factors in predicting T2D and IFG.We observed an increased prevalence of T2D in RA patients when compared with age- and gender-matched controls. Regression analyses demonstrated that the presence of high blood pressure (HBP), a longer disease duration, and exposure to corticosteroids (CCS) were significantly associated with an increased likelihood of being classified as T2D. In addition, we observed an increased prevalence of IFG in RA patients when compared with age- and gender-matched controls. Regression analyses demonstrated that a higher body mass index (BMI), the presence of metabolic syndrome (MetS), higher levels of total cholesterol, the presence of radiographic damage, and higher serum levels of C-reactive protein (CRP) were significantly associated with an increased likelihood of presenting IFG.In this cross-sectional study, we observed an increased prevalence of T2D and IFG in an Italian cohort of RA patients when compared with age- and gender-matched control individuals. Interestingly, both RA-specific features, such as disease duration, CCS exposure, and radiographic damage, and traditional CV risk factors, such as HBP and MetS, were significantly associated with glucose metabolism abnormalities.
尽管类风湿关节炎(RA)管理的改善显著提高了患者的长期预后,但其中很大一部分患者可能会出现包括心脏代谢并发症在内的相关合并症。然而,必须指出的是,由于对该问题的认识有限、缺乏适当的临床研究以及RA患者心血管(CV)风险降低的最佳策略,全面的心脏代谢评估仍未很好地纳入RA患者的管理中。此外,尽管多项研究调查了传统CV风险因素与RA之间可能存在的关联,但仍有相互矛盾的结果。在此基础上,我们开展了这项横断面研究,旨在调查与年龄和性别匹配的对照个体相比,RA患者中2型糖尿病(T2D)和空腹血糖受损(IFG)的患病率。此外,我们分析了传统和RA相关CV风险因素在预测T2D和IFG中的作用。我们观察到,与年龄和性别匹配的对照组相比,RA患者中T2D的患病率有所增加。回归分析表明,高血压(HBP)、疾病持续时间较长以及使用皮质类固醇(CCS)与被归类为T2D的可能性增加显著相关。此外,我们观察到,与年龄和性别匹配的对照组相比,RA患者中IFG的患病率有所增加。回归分析表明,较高的体重指数(BMI)、代谢综合征(MetS)的存在、总胆固醇水平较高、影像学损伤的存在以及血清C反应蛋白(CRP)水平较高与出现IFG的可能性增加显著相关。在这项横断面研究中,我们观察到,与年龄和性别匹配的对照个体相比,意大利RA患者队列中T2D和IFG的患病率有所增加。有趣的是,RA特异性特征,如疾病持续时间、CCS暴露和影像学损伤,以及传统CV风险因素,如HBP和MetS,均与糖代谢异常显著相关。