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Diabetes and Rheumatoid Arthritis: A Missing Link?

This post was last updated on December 2, 2019 at 9:44 pm

Is there an unidentified link between diabetes and RA?

By Jason Bhan, MD, Fernando Schwartz, PhD, and Lauren Wiener

Diabetes and rheumatoid arthritis (RA) are certainly two of the most common and well-known diseases faced by the US population today.  While it may seem that we know plenty about these two conditions, recently Prognos set out to discover more.  Although diabetes and RA may not seem very similar, they do share the physiological link of causing an inflammatory response, and we wondered if they might share even more.

Could there be a link between diabetes and RA?  Smaller research papers have conducted investigations to suggest they could be a comorbidity between the two conditions, but this is not mentioned in the current standard of care.  Follow along in our latest blog series to learn if our research suggests the same.

Background

Diabetes is a disease in which the body’s ability to produce or respond to insulin is impaired, leading to higher levels of glucose in the blood. Currently, 6.5% of the population suffers from type 2 diabetes.  Diabetes is indicative of poor health in general, and is associated with obesity, poor cardiovascular health, and many other conditions.  Systemic inflammation may be associated with diabetes, which may also account for inflammatory comorbid conditions.

Rheumatoid arthritis is an autoinflammatory disease in which the body produces antibodies that causes the body to attack itself. This inflammation affects a patient’s joints, causing stiffness, swelling, and pain. The underlying inflammation that RA causes can also affect other parts of the body, such as the skin, lungs, and cardiovascular system.

Both diabetes and RA are systemic inflammatory diseases.  Given this shared inflammatory physiology, a comorbidity between these two diseases could be expected.  A study with a sample size of 340 RA patients found that 31% had diabetes, and a similar study of 17,887 RA patients found a comorbidity with diabetes in 12.9% of RA patients. Despite these findings, current standard of care guidelines for diabetes and RA do not account for this comorbidity. Rheumatoid arthritis and diabetes patients can benefit from prevention and early intervention, so this overlooked comorbidity may be indicative of a missed opportunity to improve outcomes.

Hypothesis and Associated Risks

We believe that our analysis will point to a comorbidity between diabetes and RA, and we hope to demonstrate this comorbidity on a larger scale. Furthermore, we will investigate if RA patients with a double positive diagnosis will be affected by the presence of a diabetes comorbidity. A double positive diagnosis is defined as RF+ and anti-CCP+, which are both measures of autoantibody levels in rheumatoid arthritis.

Study Design

To determine the comorbidity of diabetes and RA, we will search through our expansive database, The Prognos Registry, and diagnose patients with diabetes, RA, and with a double positive diagnosis of RA. We will calculate the prevalence of diabetes and RA, as well as the percentage of RA patients who have diabetes. This last statistic can be compared to the smaller studies that have reported high levels of comorbidity. We will also find the occurrence of double positive RA diagnosis in comorbid patients as compared to patients with only RA, and perform a chi square test to determine if there is a statistically significant difference between the two populations.

What’s to Come…

Our team looks forward to sharing the findings of our investigation with our readers over the next few weeks.  Follow along with us to read what we’ve found, and feel free to reach out to us with questions or to request additional information.

Reading List

Disclosure: Study funded by Prognos, New York, NY.