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Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis
Open Access Articles
  • Siri Lillegraven, Diakonhjemmet Hospital
  • Jeffrey D. Greenberg, NYU Hospital for Joint Diseases
  • George W. Reed, University of Massachusetts Medical School
  • Katherine Saunders, Corrona, LLC
  • Jeffrey R. Curtis, University of Alabama, Birmingham
  • Leslie R. Harrold, University of Massachusetts Medical School
  • Marc C. Hochberg, University of Maryland - Baltimore
  • Dimitrios A. Pappas, Columbia University
  • Joel M. Kremer, Albany Medical College
  • Daniel H. Solomon, Brigham and Women's Hospital
UMMS Affiliation
Department of Medicine, Division of Rheumatology
Publication Date
Document Type

OBJECTIVE: Inflammation and anti-inflammatory treatments might influence the risk of diabetes. The objective of this study was to assess factors associated with incident diabetes in rheumatoid arthritis (RA).

METHODS: The study population consisted of RA patients from a multi-center cohort study, Corrona. To assess risk associated with disease modifying antirheumatic drug (DMARD) exposure, we assessed five mutually exclusive DMARD groups. Additionally, we assessed the risk associated with body mass index (BMI, < 25, 25-30, > 30 kg/m2) and glucocorticoid usage. Incident cases of diabetes were confirmed through adjudication, and Cox regression models were fit to estimate the risk of incident diabetes.

RESULTS: We identified 21,775 DMARD treatment regimens, the mean (SD) age at the index visit was 58 (13) years, disease duration 10 (10) years, and 30% used oral glucocorticoids at the time. Eighty-four incident cases of diabetes were confirmed within the treatment exposure periods. The hazard ratio (HR, 95% confidence interval) for diabetes was significantly reduced in patients receiving TNF inhibitors, HR 0.35 (0.13, 0.91), compared to patients treated with non-biologic DMARDs other than hydroxychloroquine and methotrexate. Hydroxychloroquine, methotrexate and use of other biologic DMARDs had a numerically reduced risk compared to the same group. Patients prescribed > /=7.5 mg of glucocorticoids had a HR of 2.33 (1.68, 3.22) of incident diabetes compared with patients not prescribed oral glucocorticoids. RA patients with a BMI > 30 had a HR of 6.27 (2.97, 13.25) compared to patients with BMI < /=25.

CONCLUSION: DMARDs, glucocorticoids and obesity influenced the risk of incident diabetes in a large cohort of RA patients. Monitoring for the occurrence of diabetes should be part of routine RA management with a focus on specific subgroups.

  • Diabetes mellitus,
  • Rheumatoid arthritis,
  • Methotrexate,
  • Body mass index,
  • Obesity,
  • Diabetes diagnosis and management,
  • Comparators,
  • Cytokines
Rights and Permissions
Copyright: © 2019 Lillegraven et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI of Published Version

PLoS One. 2019 Jan 23;14(1):e0210459. doi: 10.1371/journal.pone.0210459. eCollection 2019. Link to article on publisher's site

Related Resources

Link to Article in PubMed

PubMed ID
Creative Commons License
Creative Commons Attribution 4.0
Citation Information
Siri Lillegraven, Jeffrey D. Greenberg, George W. Reed, Katherine Saunders, et al.. "Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis" Vol. 14 Iss. 1 (2019) ISSN: 1932-6203 (Linking)
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