Clinical Characteristics Of Rheumatoid Arthritis With Type 2 Diabetes Mellitus

Objective:Rheumatoid arthritis(RA)is a chronic systemic autoimmune disease characterized by aggressive symmetrical polyarthritis.The prevalence rate is1%in the world while 0.32%to 0.36%in China.There is a large number of population in China so that the actual cases is much higher than the other countries.Diabetes mellitus(DM)is a group of metabolic diseases characterized by chronic hyperglycemia caused by multiple factors,due to deficiency of insulin secretion and/or utilization.Diabetes is a major component of metabolic syndrome.The study found that the probability of connective tissue disease complicated with prediabetes was higher than that of other diseases.Foreign surveys showed that the prevalence of diabetes mellitus in patients with RA was about 15%to 19%.Data from China showed that the prevalence rate of diabetes was 20%in patients with RA,which was significantly higher than that in the general population.The occurrence of DM accompany with RA was higher than that of ordinary people in China,which was gradually attracted worldwide attention.In this study,a case-control study was used to evaluate the basic clinical characteristics,inflammation indexes,glucose metabolism in patients with rheumatoid type 2 diabetes mellitus,patients only with rheumatoid disease and healthy control.To analyze the clinical characteristics and the correlation between patients of RA combine with type 2 diabetes mellitus,and further explore the possible mechanism of RA associated with abnormal glucose metabolism,so as to find the scientific theoretical basis for the treatment of RA with diabetes mellitus.Prevention of neopathy caused by two highly disabled diseases so as to provide reference for clinical treatment.Methods:From March 2014 to March 2018,42 patients with RA combined with T2DM and 82 patients with RA treated in the Department of Endocrinology and rheumatism immunology of Chengde Central Hospital initially were selected as RA combined with T2DM group and RA alone group respectively,and 90 health check-up personnel in Chengde Central Hospital physical examination center during the same period were selected as healthy control group.The endocrine and rheumatological immunology department of Chengde Central Hospital was consulted in the discharge registration from March 2014 to March 2018,and calculating the names and hospitalization numbers of eligible rheumatoid arthritis patients.Detailed access to medical records of patients with rheumatoid arthritis in the medical records management department,fill in paper form.The data of those patients were recorded including general data:sex,age,weight,height,body mass index(BMI),disease duration(less than 5 years,5-10 years,more than 10 years),swelling joint number(SJC),tenderness joint count(TJC)and clinical medication(using GC or not),systolic blood pressure(SBP),diastolic blood pressure(DBP);Disease activity index:erythrocyte sedimentation rate(ESR),DAS28 score,platelet(PLT),C-reactive protein(CRP),rheumatoid factor(RF);indicators of glucose and lipid metabolism was analyzed and processed by SPSS 21.0 statistical software.The difference between the two groups of normal distribution data was analyzed by independent sample t test,and the measured data were expressed as mean±standard deviation(x±s).The counting data were expressed byχ~2.Pearson correlation analysis was used to evaluate the correlation between HOMA-IR and CRP,ESR,DAS28.There was a significant difference in P<0.05.Results:1.Comparison of general clinical and glycometabolism indexes between simple RA group and healthy control groupThere was no significant difference in age,sex composition,BMI and HOMA-βbetween the two groups.FPG,FINS,HbA1c and HOMA-IR were higher than those of the control group(P<0.05).2.Comparison of glucose metabolism and IR in RA patients with different disease activitiesThe patients in RA group were divided into two groups according to the DAS28 score:the DAS28 score>5.5 was the high activity group,and the DAS28 score<5.5 was the low and moderate activity group.There was no significant difference in age,BMI,FPG and HOMA-beta between the two groups.The FINS,HbA1c and HOMA-IR values in high activity group were higher than those in low and moderate activity,and the difference was statistically significant.3.Relevant factors of HOMA-IR in simple RA groupHOMA-IR was positively correlated with DAS28 activity score(r=0.376,P<0.05),CRP(r=0.286,P<0.05)and ESR(r=0.482,P<0.05).4.Comparison of general clinical features,glycolipid metabolism and disease activity between RA with type 2 diabetes mellitus and RA aloneThere were no significant differences in sex composition,disease duration,use of hormone,SJC,TJC,SBP,DBP,TG,LDL-C,HDL-C,RF,PLT,HOMA-beta between RA combined with type 2 diabetes mellitus and RA alone.The average age,BMI,TC,ESR,CRP,DAS28 score,FPG,FINS,HbA1c and HOMA-IR of RA patients with type 2 diabetes mellitus were higher than those of RA patients alone,the difference was statistically significant(P<0.05).Conclusions:1.The levels of FPG,FINS and HbA1c in patients with simple RA were higher than those in healthy people,indicating that insulin resistance index(HOMA-IR)in patients with simple RA was higher than that in healthy people,indicating that insulin resistance existed in patients with RA.2.The FINS and HOMA-IR values of patients with RA with high disease activity were higher than those of patients with moderate or low disease activity,suggesting that those with high inflammatory status were more likely to develop insulin resistance.3.The HOMA-IR quantity of RA patients is positively correlated with DAS28 score,CRP,ESR,which confirms the role of inflammation in the formation of insulin resistance in RA patients.It indicates that the level of inflammation in RA patients may be correlated with the degree of insulin resistance.Blocking the inflammatory immune response may provide new ideas for the prevention and treatment of IR in RA patients.4.The age,BMI,TC,ESR,CRP,DAS28 score,FPG,FINS and HOMA-IR of RA patients with type 2 diabetes mellitus were higher than those of RA patients alone.Age may be a risk element for diabetes mellitus in patients with RA.Inflammation reaction not only participates in the pathogenesis of insulin resistance in RA patients,but also in the process of insulin resistance.RA patients with type 2 diabetes mellitus showed high body mass index and abnormal lipid metabolism.