TYPE 2 DIABETES MELLITUS RISK ASSESSMENT USING FINDRISC IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objective: to investigate the prevalence of traditional risk factors (RFs) and to determine a 10-year risk for type 2 (T2) diabetes mellitus (DM), by using the Finnish Diabetes Risk Score (FINDRISC) in patients with rheumatoid arthritis (RA).

Subjects and methods. The investigation enrolled 418 RA patients without a history of DM. The median age of the participants was 54 [41; 63] years; the median disease duration was 6 [2; 12] years. Most of the patients were positive for rheumatoid factor (75.6%) and anti-cyclic citrullinated peptide antibodies (77.3%) and had moderate and high RA activity (81.8%). Glucocorticoids (GCs), disease-modifying anti-rheumatic drugs, and biological agents were used in 42.1, 66.7, and 23.9% of the patients, respectively. FINDRISC was used to assess the risk of T2DM. A control group consisted of 100 gender- and age-matched individuals without inflammatory joint diseases or DM.

Results and discussion. The most common modifiable traditional RFs in RA were abdominal obesity (AO) (63.6%), overweight (50.7%), and lack of physical activity (70.3%); the non-modifiable RF was age older than 45 years (69.1%). The RA and control groups showed the similar prevalence of RFs, except for AO that was more common in the absence of inflammatory joint diseases (75.0%) (p = 0.03). The number of RFs did not differ in RA patients (median RFs, 4 [2; 5]) and control individuals (4 [3; 5]) (p = 0.23). The moderate risk of developing T2DM in the ensuing ten years was 20.1 and 18.0% in RA patients and control individuals, respectively; the high risk was in 19.6 and 24.0% and the very high risk was in 2.7 and 2.0%, respectively (p > 0.05 in all cases). In RA, there was a weak correlation between the number of RFs and DAS28 (r = 0.10; p = 0.05), RFs and HAQ (r = 0.19; p < 0.01). Examinations detected fasting hyperglycemia (glucose ≥6.1 mmol/l) in 3.8% of the RA patients with a low/slightly increased risk for T2DM and in 16.1% of those with its moderate, high, and very high risks (p < 0.01). The use of GCs did not affect the number of RFs, the distribution of groups at risk for DM, and the frequency of hyperglycemia. These findings can lead to the conclusion that the risk of developing T2DM in RA is associated with a high frequency of modifiable traditional RFs, such as obesity and lack of physical activity. FINDRISC is a simple method to identify RA patients who need lifestyle monitoring and modification, as well as an additional examination to rule out latent T2DM.

1. Jiang P, Li H, Li X. Diabetes mellitus risk factors in rheumatoid arthritis: a systematic review and meta-analysis. Clin Exp Rheumatol. 2015;33(1):115-21.

2. Dessein PH, Joffe BI. Insulin resistance and impaired beta-cell function in rheumatoid arthritis. Arthritis Rheum. 2006;54(9):2765-75. doi: 10.1002/art.22053

3. Chung CP, Oeser A, Solus JF, et al. Inflammation-associated insulin resistance: differential effects in rheumatoid arthritis and systemic lupus erythematosus define potential mechanisms. Arthritis Rheum. 2008;58(7):2105-12. doi: 10.1002/art.23600

4. Hoes JN, van der Goes MC, van Raalt DH, et al. Glucose tolerance, insulin sensitivity and β- cell function in patients with rheumatoid arthritis treated with or without low-to-medium dose glucocorticoids. Ann Rheum Dis. 2011;70;70(11):1887-94. doi: 10.1136/ard.2011.151464

5. Movahedi M, Beauchamp ME, Abrahamowicz M, et al. Risk of incident diabetes mellitus associated with the dosage and duration of oral glucocorticoid therapy in patients with rheumatoid arthritis. Arthritis Rheum. 2016;68(5):1089-98. doi: 10.1002/art.39537

6. Baghdadi LR, Woodman RJ, Shanahan EM, Mangoni AA. The impact of traditional cardiovascular risk factors on cardiovascular outcomes in patients with rheumatoid arthritis: a systematic review and meta-analysis. PLoS ONE. 2015;10(2):e0117952. doi: 10.1371/journal.pone.0117952

7. Iwanaga N, Arima K, Terada K. Risk factors of adverse events during treatment in elderly patients with rheumatoid arthritis: an observational study. Int J Rheum Dis. 2017;20(3):346- 52. doi: 10.1111/1756-185X.12348

8. Lindstrom J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003:26(3):725-31. doi: 10.2337/diacare.26.3.725

9. Дедов ИИ, Шестакова МВ, Александров АА и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом (5-й выпуск). Сахарный диабет. 2011;(3s):2-72 [Dedov II, Shestakova MV, Aleksandrov AA, et al. Algorithms of specialized medical care for diabetes mellitus patients. Sakharnyi Diabet = Diabetes Mellitus. 2011; (3s):2-72 (In Russ.)]. doi: 10.14341/2072-0351-5612

10. Насонов ЕЛ, редактор. Ревматология. Клинические рекомендации. Москва: ГЭОТАР-Медиа; 2010 [Nasonov EL, editor. Revmatologiya. Klinicheskie rekomendatsii [Rheumatology. Clinical guidelines]. Moscow: GEOTAR-Media; 2010].

11. Дедов ИИ, Шестакова МВ, Галстян ГР. Распространенность сахарного диабета 2 типа у взрослого населения России (исследование NATION). Сахарный диабет. 2016;19(2):104-12 [Dedov II, Shestakova MV, Galstyan GR. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Sakharnyi Diabet = Diabetes Mellitus. 2016;19(2):104-12 (In Russ.)]. doi: 10.14341/DM2004116-17

12. Solomon DH, Love TJ, Canning C, Schneeweiss S. Risk of diabetes among patients with rheumatoid arthritis, psoriatic arthritis and psoriasis. Ann Rheum Dis. 2010;69(12):2114-7. doi: 10.1136/ard.2009.125476

13. Wolf F, Michaud K. The effect of body mass index on mortality and clinical status in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64(10):1471-9. doi: 10.1002/acr.21627

14. Ajeganova S, Andersson ML, Hafstrom I. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: A long-term followup from disease onset. Arthritis Care Res (Hoboken). 2013;65(1):78-87. doi: 10.1002/acr.21710

15. Гриднева ГИ, Муравьев ЮВ, Лучихина ЕЛ и др. Вопросы оптимизации терапии метотрексатом у больных ревматоидным артритом. Научно-практическая ревматология. 2017;55(1):41-7 [Gridneva GI, Muravyev YuV, Luchikhina EL, et al. Issues of optimization of methotrexate therapy in patients with rheumatoid arthritis. Nauchno- Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2017;55(1):41-7 (In Russ.)]. doi: 10.14412/1995-4484-2017-41-47

16. Tilg H, Moschen AR. Adipocytokines: mediators linking adipose tissue, inflammation and immunity. Nat Rev Immunol. 2006;6(10):772-83. doi: 10.1038/nri1937

17. Galic S, Oakhill JS, Steinberg GR. Adipose tissue as an endocrine organ. Mol Cell Endocrinol. 2010;316(2):129-39. doi: 10.1016/j.mce.2009.08.018

18. Мустафина СВ, Рымар ОД, Сазонова ОВ и др. Валидизация финской шкалы риска «FINDRISC» на европеоидной популяции Сибири. Сахарный диабет. 2016;19(2):113-8 [Mustafina SV, Rymar OD, Sazonova OV, et al. Validation of the Finnish diabetes risk score (FINDRISC) for the Caucasian population of Siberia. Sakharnyi Diabet = Diabetes Mellitus. 2016;19(2):113-8 (In Russ.)]. doi: 10.14341/DM200418-10

19. Баланова ЮА, Концевая АВ, Шальнова СА и др. Распространенность поведенческих факторов риска сердечно-сосудистых заболеваний в российской популяции по результатам исследования ЭССЕ-РФ. Профилактическая медицина. 2014;(5):42-52

20. Balanova YuA, Kontsevaia AV, Shal'nova SA, et al. Prevalence of behavioral risk factors for cardiovascular disease in the Russian population: Results of the ESSE-RF epidemiological study. Profilakticheskaya Meditsina. 2014;(5):42-52 (In Russ.)].

21. Муромцева ГА, Концевая АВ, Константинов ВВ и др. Распространенность факторов риска неинфекционных заболеваний в российской популяции в 2012–2013 гг. Результаты исследования ЭССЕ-РФ. Кардиоваскулярная терапия и профилактика. 2014;(6):4-11 [Muromtseva GA, Kontsevaya AV, Konstantinov VV, et al. The prevalence of non-infectious diseases risk factors in russian population in 2012–2013 years. The results of ECVD-RF. Kardiovaskulyarnaya Terapiya i Profilaktika = Cardiovascular Therapy and Prevention. 2014;13(6):4-11 (In Russ.)]. doi: 10.15829/1728-8800-2014-6-4-11

22. Primdahl J, Clausen J, Horslev-Petersen K. Results from systematic screening for cardiovascular risk in outpatients with rheumatoid arthritis in accordance with the EULAR recommendations. Ann Rheum Dis. 2013;72(11):1771-6. doi: 10.1136/annrheumdis-2013-203682

23. Ozen G, Pedro S, Holmqvist ME, et al. Risk of diabetes mellitus associated with disease- modifying antirheumatic drugs and statins in rheumatoid arthritis. Ann Rheum Dis. 2017;76:848-54. doi: 10.1136/annrheumdis-2016-209954