Diabetes mellitus and insulin resistance in patients with rheumatoid arthritis: risk reduction in a chronic inflammatory disease
Department of Medicine, Division of Rheumatology
Medical Subject Headings
Animals; Arthritis, Rheumatoid; Chronic Disease; Diabetes Mellitus, Type 2; Humans; Inflammation Mediators; Insulin Resistance; Randomized Controlled Trials as Topic; *Risk Reduction Behavior
Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases
OBJECTIVE: To perform a systematic literature review of the potential association among molecular markers of inflammation, alterations in body composition, and insulin resistance (IR), a precursor to type 2 diabetes mellitus (DM), in rheumatoid arthritis (RA) patients. To determine the impact of tumor necrosis factor alpha (TNFalpha) as a pivotal proinflammatory cytokine in the pathophysiology of type 2 DM and RA, and the effect of antirheumatic drugs on glycemic control.
METHODS: We performed a search of PubMed to identify articles on IR and body habitus in patients with RA.
RESULTS: Patients with RA had characteristics placing them at high risk for IR and type 2 DM. The incidence and prevalence of type 2 DM in RA was not clearly increased compared with the general population; however, studies suggested that patients with RA are likely to have IR and have increased risk of cardiovascular disease (CVD). The prevalence of type 2 DM and IR could be estimated from reports of risk factors for CVD in RA patients. The TNFalpha antagonists provided rapid and effective control of RA-related inflammation. Evidence indicated that extended use of TNFalpha antagonists in RA may provide the additional benefit of improving insulin sensitivity. These treatment-related changes may contribute to an overall reduction in the risk of type 2 DM and CVD in RA patients.
CONCLUSION: Controlling inflammation may improve insulin sensitivity and subsequently reduce the risk of developing type 2 DM in RA patients. This may also reduce the risk of CVD in this high-risk group. Future studies are required to elucidate the relationships between inflammation, body composition, IR, TNFalpha antagonist use, and the risk of developing type 2 DM in RA patients.
Rights and Permissions
Citation: Arthritis Care Res (Hoboken). 2011 Apr;63(4):512-21. doi: 10.1002/acr.20414. Link to article on publisher's site
Wasko, Mary Chester; Kay, Jonathan; Hsia, Elizabeth C.; and Rahman, Mahboob U., "Diabetes mellitus and insulin resistance in patients with rheumatoid arthritis: risk reduction in a chronic inflammatory disease" (2011). Rheumatology Publications and Presentations. 117.