Severe T2D With Insulin Resistance May Complicate Rheumatoid Arthritis Cases

Arthritic seniors hands cutting flowers
Rheumatoid arthritis and osteoarthritis patients can experience poorly controlled severe type 2 diabetes, say French researchers who suggest considering targeting insulin resistance through treatment for joint and systemic inflammation.

Rheumatoid arthritis patients can experience severe type 2 diabetes (T2D) with suboptimal metabolic control, shows a study recently published in Rheumatology.

Because the conditions share similar characteristics, such insulin resistance, French researchers sought to determine the influence of rheumatoid arthritis and osteoarthritis on TD2-related complications, metabolic control and insulin resistance.

This was an observational, multicenter, cross-sectional study of 118 with patients with rheumatoid arthritis and 49 patients with osteoarthritis from 7 treatment centers in France.

After adjusting for age, body mass index and corticosteroid use, insulin resistance was found to be significantly higher in rheumatoid arthritis patients than in osteoarthritis patients. Rheumatoid arthritis patients were found to have insulin resistance associated with joint and systemic inflammation.

Patients with rheumatoid arthritis were younger (mean, 63.8 vs 69.6 years; P =.003) and with lower body mass indexes (mean, 27.7 vs 31.8 kg/m2; P <.001) compared with patients who had osteoarthritis.

Although patients with rheumatoid arthritis were younger and had lower body mass indexes, characteristics of T2D were similar between patient cohorts. Average glycated hemoglobin was 7.3%±1.29% and 7.0%±1.19%, 59.1% and 55.0% were on metformin, and 18.4% and 14.4% were on gliclazide among the osteoarthritis and rheumatoid arthritis cohorts, respectively.

Patients with rheumatoid arthritis were more likely to exhibit insulin secretion (P <.001), reduced insulin sensitivity (P <.001), and insulin resistance (P <.001). Insulin sensitivity was associated with body mass index (r, -0.50; P <.001), abdominal circumference (r, -0.45; P <.001), and age (r, -0.41; P =.037) among patients with OA. These trends were not observed among patients with rheumatoid arthritis.

In an adjusted multivariate model, decreased insulin sensitivity was associated with C-reactive protein >10 mg/l (odds ratio [OR], 6.92; 95% CI, 1.61-29.71; P =.009) or DAS28 >3.2 (OR, 4.46; 95% CI, 1.17-17.08; P =.019).

Among patients with rheumatoid arthritis patients, glycemic control was not correlated with disease severity (r, -0.03; P =.771) or C-reactive protein (r, -0.029; P =.776), but with bone erosions (OR, 4.43; 95% CI, 1.18-16.61; P =.027).

Rheumatoid arthritis patients who were treated with anti-tumor necrosis factor-a were more likely to have increased sensitivity to insulin (58.71% vs 32.5%; P =.001).

These findings suggest that patients with rheumatoid arthritis and T2D may display a biological profile of systemic inflammation with insulin resistance, indicating the possibility of a possible therapeutic avenue through the inflammatory response.

“Osteoarthritis and rheumatoid arthritis patients with adult-onset diabetes display a clinical profile of severe T2D with suboptimal metabolic control. Rheumatoid arthritis patients displayed a biological profile of insulin resistance associated with joint and systemic inflammation,” the authors wrote. “These findings may have therapeutic implications, with the potential targeting of insulin resistance through the treatment of joint and systemic inflammation.”

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Avouac J, Elhai M, Forien M, et al. Influence of inflammatory and non-inflammatory rheumatic disorders on the clinical and biological profile of type-2 diabetes. Rheumatology. 2021;keaa810. doi:10.1093/rheumatology/keaa810.