Rheumatoid arthritis with diabetes tied to worse functional status
30 Jul 2021
Rheumatoid arthritis (RA) patients who also have diabetes mellitus (DM) are at risk of greater worsening or less improvement in functional status, reveals a study, suggesting that additional interventions may be needed to optimize treatment and management of other comorbidities.
The authors used the American College of Rheumatology’s Rheumatology Informatics System for Effectiveness (RISE) electronic health record–based registry to identify RA patients who had at least one rheumatologist visit with a Health Assessment Questionnaire (HAQ) measured in 2016 (index visit), ≥1 previous visit, and a subsequent outcome with the same HAQ measured at 12 months.
DM was identified through diagnosis codes, medications, or laboratory values. Outpatient infection was defined either by diagnosis codes or anti-infective medications.
The authors calculated mean HAQ change and incidence rate (IR) of outpatient infections among patients with and without DM. Finally, they calculated the adjusted mean HAQ change and hazard ratios (HRs) using generalized linear models and Cox regression.
A total of 3,853 RA patients with DM and 18,487 without DM were identified. The mean HAQ change between index and outcome visit was 0.03 and 0.002 among patients with and without DM, respectively (p<0.01).
Overall, 761 outpatient infections occurred in patients with DM (IR, 22.6 per 100 person-years, 95 percent confidence interval [CI], 21.0–24.2) and 3,239 in patients without DM (IR, 19.8, 95 percent CI, 19.1–20.5). The adjusted HR of outpatient infections among patients with vs without DM was 0.99 (95 percent CI, 0.91–1.07).
“Patients with RA who also have DM might have worse clinical outcomes and adverse events compared to patients with RA who do not have DM,” the authors said.