Abstract
Objective. The primary aim of this study is to underline the inflammation-lowering effect of oral antidiabetic drugs, namely the CRP, ESR and DAS28 levels. The secondary aim was to show that these effects are dependent on the dose of the antidiabetic drug. Methods. The study has an observational, case-control design. The information was gathered from the case reports of the patients that were admitted in Sf. Maria Clinical Hospital in Bucharest, beginning with 2010 and until May 2016. It included a case group of 20 subjects and a control group of 20 subjects who were followed approximately 3 years from the diagnosis of RA. Results. There were no significant group differences at baseline. During the follow-up, the medians of DAS28, CRP and ESR were significantly lower in the group treated with oral glucose lowering agents (p<0.005). Secondly, the presence of metformin both as monotherapy and in combination with other antidiabetic drugs was associated with a statistically significant decrease in the medians of the three mentioned variables (p<0.05). The metformin dose can predict the value of CRP (p=0.005), accounting for 18.9% of the variation of CRP. Moreover, there is a negative correlation between CRP level and metformin, r=-0.434, p=0.003. This negative correlation was also seen between metformin and CRP value (p=0.027), when metformin was used in monotherapy. Conclusion. The main insights achieved in this study relate to the ability of metformin to significantly lower both DAS28 and CRP level in patients with RA and T2DM, when compared to those that are affected only by RA. An element that needs further study is if these benefits can also extend to RA patients without T2DM, but with impaired glucose tolerance or important cardiovascular risk factors.
Highlights
Rheumatoid arthritis is defined as a chronic inflammatory disease, characterised by joint swelling, tenderness and synovial joint destruction, associated with a variety of systemic autoimmune manifestations, all adding to a premature mortality, functional disability and lower quality of life [1]
Regarding DAS28, C reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) levels at diagnosis, they are lower in the case group, but not at a significant level
The only statistically significant differences are observed when comparing the medians of the blood glucose level, this being with 33.15 mg/dl higher in the case group, t(38)=-6.1, p
Summary
Rheumatoid arthritis is defined as a chronic inflammatory disease, characterised by joint swelling, tenderness and synovial joint destruction, associated with a variety of systemic autoimmune manifestations, all adding to a premature mortality, functional disability and lower quality of life [1]. The immune mechanisms that lead to RA are complex and have repercussions at the joint level, and on metabolic processes and the endothelial function. The presence of autoantibodies can be detected starting with this phase and their serum concentration begins to rise in the second phase. These two phases pertain to the subclinical stage of the disease, which is characterised by the absence of symptoms and detection of serum autoantibodies and inflammatory markers in the second phase. These two phases pertain to the subclinical stage of the disease, which is characterised by the absence of symptoms and detection of serum autoantibodies and inflammatory markers in the second phase. [3]
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