Medication Used to Treat RA May Also Reduce the Risk of Diabetes in These Patients

The use of an antimalarial medication may prevent the development of diabetes in patients with rheumatoid arthritis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.

Diabetes affects nearly eight percent of the population and is a major cause of morbidity and death due to complications that include coronary heart disease, kidney failure and blindness. Rheumatoid Arthritis is a systemic autoimmune disease affecting about 1 percent of the population that causes pain, stiffness, swelling and reduced mobility and function of multiple joints. Despite multiple risk factors for diabetes, including treatment with steroids and sedentary lifestyle, people with RA are not affected by diabetes more than the general population. The use of hydroxychloroquine—a medication developed to treat malaria and is currently used to treat some autoimmune diseases—may be the reason for the unexpectedly low rate of diabetes in RA.

A 2007 study published in the Journal of the American Medical Association showed a 77 percent reduction in new cases of diabetes in patients with RA who were taking hydroxychloroquine for over four years. A limitation of the study, however, was that all data was collected by mailed questionnaires to patients with RA.

Researchers recently used an electronic health records database with physician-coded diagnoses and laboratory measures to corroborate the results of the 2007 study. They used the database to identify 1,824 patients with RA without diabetes and collected data such as demographics, body mass index, laboratory results and medication use. Of the participants, 74 percent were women and 97 percent were Caucasian; they had a mean age of 62.4 years and a body mass index of 29.3.

Participants were divided into groups based on their previous use of hydroxychloroquine and rates of new cases of diabetes were compared for the hydroxychloroquine users and non-users.

Of the 1,824 participants, 489 had previously taken hydroxychloroquine and 1,335 had not. During observation, the rate of newly diagnosed diabetes among hydroxychloroquine users was about half the rate noted in the non-users (17.2 vs. 33.8 new cases of diabetes per 1,000 people per year). In further analysis—adjusted for demographics, body mass index, use of steroids, methotrexate and tumor necrosis factor inhibitors, and disease severity—having ever used hydroxychloroquine was associated with a 53 percent reduction in the development of new cases of diabetes.

These results confirm, and further strengthen, the previously reported protective relationship between hydroxychloroquine use and the risk of developing diabetes.

“In patients with rheumatoid arthritis, use of hydroxychloroquine may reduce the risk of developing diabetes by 53 percent, explains Androniki Bili, MD, MPH; rheumatology, Geisinger Health System, Danville, Pa., and lead investigator in the study. “Given the favorable safety profile and low cost of this generic medication, these findings may have implications for the use hydroxychloroquine for prevention of diabetes in other high risk groups.”