Service de Rhumatologie, Université de Paris, Hôpital Cochin, AP-HP.CUP, Paris, France.
Service de Rhumatologie, Université de Paris, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.
Rheumatology (Oxford). 2021 Aug 2;60(8):3598-3606. doi: 10.1093/rheumatology/keaa810.
To study the profile of type-2 diabetes (T2D) in patients with RA or OA.
This observational, multicentre, cross-sectional study included, over a 24-month period, consecutive patients with adult-onset diabetes and RA or OA. We collected demographics, disease activity and severity indices, current treatments for RA and diabetes, history and complications of diabetes. A systematic blood test was performed, assessing inflammatory, immunological and metabolic parameters. The homoeostasis model assessment (HOMA)2-S was used to assess insulin resistance.
We included 167 patients with T2D, 118 with RA and 49 with OA. RA and OA patients had severe T2D with suboptimal metabolic control and a biological profile of insulin resistance. Insulin resistance was significantly higher in RA than in OA patients after stratification on age, BMI and CS use [HOMA2-S: 63.5 (35.6) vs 98.4 (69.2), P < 0.001]. HOMA2-S was independently associated with DAS28 [odds ratio (OR): 4.46, 95% CI: 1.17, 17.08]. T2D metabolic control was not related to disease activity and functional impairment, but HbA1c levels were independently associated with bone erosions (OR: 4.43, 95% CI: 1.18, 16.61). Treatment with low-dose CSs was not associated with decreased insulin sensitivity or increased HbA1c levels. Treatment with TNF-α inhibitors was associated with increased insulin sensitivity compared with patients not receiving biologics [101.3 (58.71) vs 60.0 (32.5), P = 0.001].
RA patients display severe T2D with inflammation-associated insulin resistance. These findings may have therapeutic implications, with the potential targeting of insulin resistance through the treatment of joint and systemic inflammation.
研究 2 型糖尿病（T2D）患者中类风湿关节炎（RA）或骨关节炎（OA）的发病特征。
本观察性、多中心、横断面研究纳入了在 24 个月期间连续就诊的成年起病糖尿病合并 RA 或 OA 的患者。我们收集了人口统计学、疾病活动度和严重程度指标、RA 和糖尿病的当前治疗方法、糖尿病的病史和并发症。进行了系统的血液检查，评估了炎症、免疫和代谢参数。使用稳态模型评估（HOMA）2-S 评估胰岛素抵抗。
我们纳入了 167 例 T2D 患者，其中 118 例患有 RA，49 例患有 OA。RA 和 OA 患者的 T2D 严重，代谢控制不佳，存在胰岛素抵抗的生物学特征。RA 患者的胰岛素抵抗明显高于 OA 患者，分层分析时考虑了年龄、BMI 和低剂量皮质类固醇（CS）的使用[HOMA2-S：63.5（35.6）比 98.4（69.2），P<0.001]。HOMA2-S 与 DAS28 独立相关（优势比[OR]：4.46，95%可信区间[CI]：1.17，17.08）。T2D 代谢控制与疾病活动度和功能损害无关，但糖化血红蛋白（HbA1c）水平与骨侵蚀独立相关（OR：4.43，95%CI：1.18，16.61）。低剂量 CS 治疗与胰岛素敏感性降低或 HbA1c 水平升高无关。与未接受生物制剂治疗的患者相比，TNF-α 抑制剂治疗与胰岛素敏感性增加相关[101.3（58.71）比 60.0（32.5），P=0.001]。
RA 患者表现出炎症相关的胰岛素抵抗严重的 T2D。这些发现可能具有治疗意义，通过治疗关节和全身炎症，有可能靶向胰岛素抵抗。
