Background Diabetes was found to be increased in patients with rheumatoid arthritis (RA).
Objectives The objective of this study was to evaluate the impact of hyperglycemia and diabetes on clinical activity and radiographic progression within the first 3 years in patients with early RA.
Methods Patients of the ESPOIR cohort with early RA meeting the ACR/EULAR 2010 criteria and with data available for fasting blood sugar at baseline were analyzed. Glycemic status was analyzed with 2 different definitions: i) history of type I or II diabetes; ii) baseline blood sugar splitted into 3 categories: normal (<5.55 mol/l), pre-diabetes (between 5.55 and 7 mmol/l) and diabetes (≥7 mmol/l). DAS28 and total Sharp score evolution during the first 3 years were compared between groups using multivariate mixed models. The multivariate models included the following variables: body mass index, age, gender, presence of rheumatoid factor and/or ACPA, glucorcorticoids. For DAS28 model, CRP was added in the model and for total Sharp score model, DAS28 and total Sharp were included.
Results 26 patients were known to be diabetic and 619 patients were non-diabetic. At baseline, 479 patients had normal blood sugar; 96 had pre-diabetic levels and 26 had diabetic levels. These three groups initially differed on age, body mass index, presence of rheumatoid factor, and score DAS28 Sharp erosion. In multivariate analysis, DAS28 during the first three years were significantly higher in patients with hyperglycemia (p<0.0001) and in patients with history of diabetes (p=0.05). Similarly, the structural progression was greater in patients with hyperglycemia inclusion with a dose-dependent effect (Figure 1A; p=0.006) and in patients with history of diabetes (Figure 1B; p=0.047).
Conclusions In early RA, blood sugar level is an independent predictor of disease activity and structural progression at 3 years, with a dose-dependent effect. Beyond cardiovascular complications, the measurement of blood sugar in patients with early RA may also help to assess more precisely the prognosis of the disease.
Disclosure of Interest None declared