Source: The Journal of the American Medical Association
In a study released this week, that included a decent sample size of 14,000 patients with rheumatoid arthritis or psoriasis, the use of certain disease-modifying antirheumatic drugs was found to lower the risk of diabetes.
Dr. Daniel Solomon, chief of clinical science in rheumatology at Brigham and Women's Hospital in Boston stated:
"If you have rheumatoid arthritis or psoriasis, you may be at an increased risk of diabetes, and a number of different antirheumatic drugs may reduce your future risk of diabetes."
Two common systemic inflammatory conditions, rheumatoid arthritis (RA) and psoriasis, predispose patients to insulin resistance and may place patients at risk for diabetes mellitus (DM). The treatment of psoriasis and RA includes disease-modifying antirheumatic drugs (DMARDs) such as tumor necrosis factor (TNF) inhibitors, which are directed against the inflammatory response, according to background information in the article.
The relationship between these conditions and DM suggests that systemic immunosuppression may also reduce the risk for DM.
The study's authors further explained:
"The findings from this epidemiologic study should be considered hypothesis-generating. However, considering these results in light of prior findings regarding improved insulin and glucose metabolism and reduced DM risk with hydroxychloroquine and TNF inhibitors, there is evidence suggesting a possible role for DMARDs and immunosuppression in DM prevention. A randomized controlled trial testing the ability of these agents to prevent DM among participants with systemic inflammatory disorders should be considered."
Here are the finer details of the research. The investigators then looked for those who had a prescription for at least one of the medications used for these conditions, and found that 13,905 were taking at least one of these drugs. The researchers further divided the group into four subgroups: those taking TNF inhibitors with or without other DMARDs; people taking methotrexate without a TNF inhibitor or hydroxychloroquine; hydroxychloroquine without TNF inhibitors or methotrexate; or other DMARDs without TNF inhibitors, methotrexate or hydroxychloroquine.
The study found that the rate of diabetes diagnoses over 12 years was 19.7 per 1,000 person-years for TNF inhibitors, 22.2 for hydroxychloroquine, 23.8 for methotrexate and 50.2 for other DMARDs. Compared to the other DMARDs, this translates to a reduced risk of 38% for TNF inhibitors, 23% for methotrexate and 46% for hydroxychloroquine.
Experts did say that these medications may have significant side effects. In addition, they can be expensive.
Solomon thus continues:
"The question is always, 'Is it worth giving these drugs?' You may prevent diabetes, but in doing so, will you create other problems?"
Rheumatoid arthritis, or RA, is a form of inflammatory arthritis and an autoimmune disease. For reasons no one fully understands, in rheumatoid arthritis, the immune system which is designed to protect our health by attacking foreign cells such as viruses and bacteria instead attacks the body's own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation that's systemic, meaning it can occur throughout the body.
Rheumatoid arthritis is a chronic disease, meaning it can't be cured. Most people with RA experience intermittent bouts of intense disease activity, called flares. In some people the disease is continuously active and gets worse over time. Others enjoy long periods of remission where there are disease activity or symptoms at all.
Evidence shows that early diagnosis and aggressive treatment to put the disease into remission is the best means of avoiding joint destruction, organ damage and disability.
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