Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan.
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Int J Clin Pract. 2021 Mar;75(3):e13804. doi: 10.1111/ijcp.13804. Epub 2020 Nov 9.
A previous study revealed that PPARγ agonists have anti-inflammatory effects in rheumatoid arthritis (RA). Furthermore, some studies have shown that type 2 diabetes mellitus (T2DM) may elicit the development of RA. In this study, we aimed to investigate whether the use of thiazolidinediones (TZDs) is associated with a lower risk of developing RA in patients with T2DM.
Based on the Taiwan National Health Insurance Research Database, we conducted a nationwide case-control study. The selected cases were patients with T2DM who were diagnosed with RA between 2000 and 2013. The controls were retrieved at a ratio of 1:4 by propensity score matching. Logistic regression was conducted to evaluate whether TZD use lowers the risk of RA in patients with T2DM. The dose-response effect was examined according to the total TZD dose, within 2 years before the index date (the first diagnosis date of RA), and TZD doses were divided into four groups by cumulative Defined Daily Dose (cDDD): <30, 31-90, 91-365, and >365 cDDDs.
A total of 3605 cases and 14 420 controls were included in this study. After adjusting for age, sex, baseline comorbidities, the results demonstrated that TZD use did not significantly reduce the risk of RA in patients with T2DM (adjusted OR = 0.91, 95% CI 0.81-1.02). In the subgroup analysis by total TZD exposure dose within 2 years, 91-365 cDDDs of TZD had a lower risk of RA development, aOR = 0.87 (95% CI 0.71-1.06) and >365 cDDDs of TZD, aOR = 0.85 (95% CI 0.73-1.01). In the trend test, P was <.05.
TZD use might reduce the risk of RA in patients with T2DM, but it was non-statistically significant. Further research is necessary to assess this association.
先前的研究表明，过氧化物酶体增殖物激活受体γ（PPARγ）激动剂在类风湿关节炎（RA）中具有抗炎作用。此外，一些研究表明，2 型糖尿病（T2DM）可能引发 RA 的发生。在这项研究中，我们旨在探讨噻唑烷二酮（TZD）的使用是否与 T2DM 患者发生 RA 的风险降低相关。
基于台湾全民健康保险研究数据库，我们进行了一项全国性的病例对照研究。所选病例为 2000 年至 2013 年间诊断为 T2DM 且患有 RA 的患者。对照组通过倾向评分匹配以 1:4 的比例抽取。采用 logistic 回归评估 TZD 使用是否降低 T2DM 患者发生 RA 的风险。根据总 TZD 剂量、指数日期（RA 首次诊断日期）前 2 年内的 TZD 剂量以及 TZD 剂量按累积定义日剂量（cDDD）分为四组：<30、31-90、91-365 和>365 cDDD，来评估剂量-反应效应。
本研究共纳入 3605 例病例和 14420 例对照。调整年龄、性别、基线合并症后，结果表明 TZD 使用并未显著降低 T2DM 患者发生 RA 的风险（调整后的 OR=0.91，95%CI 0.81-1.02）。在 TZD 总暴露剂量的亚组分析中，2 年内 91-365 cDDD 的 TZD 具有较低的 RA 发病风险，aOR=0.87（95%CI 0.71-1.06），>365 cDDD 的 TZD，aOR=0.85（95%CI 0.73-1.01）。趋势检验中，P<.05。
TZD 使用可能降低 T2DM 患者发生 RA 的风险，但无统计学意义。需要进一步研究来评估这种关联。
