Larger RA illness exercise, cytokine ranges linked to diabetes danger

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January 14, 2021

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Disclosure:
Baker reports advisory fees from Bristol Myers Squibb and Gilead Sciences and support from a US Veterans Affairs Merit Award. In the study you will find all relevant financial information from all other authors.

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According to the Annals of the Rheumatic Diseases, higher disease activity and higher levels of cytokines or chemokines are associated with an increased risk of diabetes mellitus in patients with rheumatoid arthritis.

“Whether and how inflammation leads to the development of diabetes remains unclear and is an important question for patients with rheumatoid arthritis who have had chronic inflammation over many years that could increase their risk.” Joshua F. Baker, MD, MSCE, of the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center, said Healio Rheumatology.

“Higher clinical disease activity in rheumatoid arthritis, as well as higher levels of circulating markers of inflammation in the blood, were linked to a higher risk of developing diabetes in the future,” Joshua F. Baker, MD, MSCE, told Healio Rheumatology. Source: Adobe Stock

To analyze the association between inflammatory disease activity – including specific cytokines and chemokines – and the development of diabetes, Baker and colleagues studied adult patients with RA who were enrolled on Veteran’s Affairs’ Register of Rheumatoid Arthritis (VARA). According to the researchers, the VARA study is an on-going national database that was established in 2003 and contains information from 13 participating VA centers. For their own study, Baker and colleagues included 1,866 VARA participants without diabetes in their longitudinal analysis at the start of the study.

Researchers rated 30 cytokines and chemokines in bank serum obtained with VARA registration. The cytokine and chemokine values ​​were then logarithmically adjusted and standardized per standard deviation. In the meantime, diabetes incident was defined based on validated algorithms using diagnostic codes and drugs. Baker and colleagues used multivariable Cox proportional hazard models to examine the relationships between clinical factors and diabetes, and to adjust age, sex, race, smoking, BMI, and basic drug use.

Joshua F. Baker

According to the researchers, there were 130 cases of diabetes during the 9,223 person-year follow-up period. High Disease Activity Score (DAS28) -C-reactive protein (CRP), obese BMI, older age, and male gender were all linked to a higher risk of diabetes, while current smoking and methotrexate use were protective. Patients using methotrexate showed a lower risk of diabetes. Several cytokines and chemokines were independently associated – per 1 SD – with diabetes, including IL-1, IL-6, and selected macrophage-derived cytokines or chemokines. These associations were independent of DAS28-CRP.

“Higher clinical disease activity in rheumatoid arthritis, as well as higher levels of circulating markers of inflammation in the blood, were associated with a higher risk of developing diabetes in the future, even after weight differences and other factors were taken into account,” Baker told Healio Rheumatology.

“While our observational study is not final, it suggests that better control of rheumatoid arthritis could help prevent this complication,” he added. “It also provides clues as to the role of inflammation as a mechanism for the development of diabetes and could suggest that inflammation may be involved in other contexts – such as Other autoimmune diseases – could also increase the risk of diabetes, although studies are needed in these populations. ”

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