Type 2 diabetes mellitus, glycaemic control, associated therapies and risk of rheumatoid arthritis: a retrospective cohort study.

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To compare the incident risk of rheumatoid arthritis (RA) in patients with type 2 diabetes mellitus (T2DM), and to explore the role of glycaemic control and associated therapeutic use on the onset of RA.This study was a retrospective cohort study using patients derived from the IQVIA medical research database (IMRD-UK) between 1995 and 2019. 224 551 newly diagnosed patients with T2DM were matched to 449 101 patients without T2DM and followed up to assess their risk of RA. Further analyses investigated the effect of glycaemic control, statin use, and anti-diabetic drugs on the relationship between T2DM and RA using time-dependent Cox regression model.During the study period, the incidence rate for RA was 8.1 and 10.6 per 10 000 person-years in the exposed and unexposed groups respectively. Following adjustment, the hazard ratio (aHR) was 0.73 (95% CI 0.67-0.79). In patients who had not used statins in their lifetime, the aHR was 0.89 (95% CI 0.69-1.14). When quantifying the effects of glycaemic control, anti-diabetic drugs and statins using time-varying analyses, there was no association with glycaemic control (aHR 1.00 (95% CI 0.99-1.00)), use of metformin (aHR 1.00 (95% CI 0.82-1.22)), dipeptidyl peptidase-4 inhibitors (DPP4i) (aHR 0.94 (95% CI 0.71-1.24)), and the development of RA. However, statins demonstrated a protective effect for progression of RA in those with T2DM (aHR 0.76 (95% CI 0.66-0.88), with evidence of duration-response relationship.There is a reduced risk of RA in patients with T2DM, that may be attributable to the use of statins.

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Authors: Dawit T Zemedikun, Krishna Gokhale, Joht Singh Chandan, Jennifer Copper, Janet M Lord, Andrew Filer, Marie Falahee, Krishnarajah Nirantharakumar, Karim Raza


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