DIABETES MELLITUS AND HYPERGLYCEMIA IN PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

Proinflammatory cytokines involved in the pathogenesis of rheumatoid arthritis (RA) can inhibit insulin production and cause insulin resistance in peripheral tissues. It is possible that with RA, the risk of developing disorders of carbohydrate metabolism (DCM) increases: diabetes mellitus (DM), fasting hyperglycemia (FH), impaired glucose tolerance. Patients with a combination of RA and DM belong to the category of the most severe patients with an unfavorable prognosis of macro- and microvascular complications. The aim of the study was to evaluate the frequency of NUO (DM and GN) in a cohort of patients with RA and their possible effect on the course of arthritis. Material and methods. The study included 165 patients (28 men, 137 women), with an average age of 55 [47; 61] years. 86.3% of patients were seropositive for rheumatoid factor, 78.8% for antibodies to cyclic citrullinated peptide. RA activity was low in 29.1% of patients, moderate – in 48.5%, high – in 22.4%. Glucocorticoids (HA) were received by 40.6% of patients (at an average dose of 5 [5; 7.5] mg / day), methotrexate – 72.7%, leflunomide 8.5%, genetically engineered biological drugs – 23.7%. A survey of patients was conducted to identify awareness of the presence of NUO and a study of fasting glucose levels in venous plasma for screening hyperglycemia. The height and body weight of the patients were measured, and the body mass index (BMI) was calculated. The results of the study. NUO was present in 21 (12.7%) of 165 patients with RA. Only 11 (6.7%) of 165 patients with RA knew about the presence of DM in them (2 cases of type 1 diabetes, 9 cases of type 2 diabetes), in the remaining 10 patients with NUO (8 patients with GN, 2 patients with type 2 diabetes) were detected during laboratory examination. Patients with DM and GN had a large number of painful joints (CHBS), more high assessment of the patient's general health status (OED) and DAS28 than patients with normoglycemia, but they did not differ in the duration of RA, the level of acute phase parameters (ESR, CRP), and the number of swollen joints. Overweight was observed in 57 (34.5%), obesity in 39 (23.6%) patients. Against the background of taking HA, glucose levels were lower (5.1 [4.7; 5.5]) than in patients without GC therapy (5.4 [5.0; 5.9] mmol/L, p=0.001), and correlated with BMI (r=0.3, p=0.01). Conclusion. The high frequency of DM and GN in RA, low awareness of patients about them, as well as the relationship have been demonstrated NUO with the activity of arthritis, mainly due to changes in subjective indicators (OOZP, BBS). Blood glucose levels in RA may be affected by taking GC and BMI.