Abstract
ObjectiveType 2 diabetes is associated with chronic, low-grade inflammation and could potentially trigger the progression of other, more prominent inflammatory diseases such as rheumatoid arthritis (RA). Therefore, we aimed to investigate the risk of incident RA in Taiwanese patients with type 2 diabetes using a population-based health claims database.MethodsThis nationwide, population-based, case-control study used administrative data to identify 1,416 patients with RA (age ≥20 years) as cases and 7,080 controls that were frequency-matched for sex, 10-year age group, and year of catastrophic illness certificate application date (index year). All subjects were retrospectively traced back, up to 13 years prior to the index year, for their first diagnosis of type 2 diabetes. Logistic regression analysis was conducted to quantify the association between incident RA and type 2 diabetes.ResultsThe odds of developing RA were significantly higher in female (odds ratio [OR] 1.46, 95% confidence interval [95% CI] 1.24–1.72) but not in male (OR 1.00, 95% CI 0.72–1.37) patients who had previously diagnosed with type 2 diabetes. Subgroup analysis indicated that the odds of developing RA were more prominent in younger females (20 to 44 years of age) with type 2 diabetes. In addition, the odds of developing RA in female patients with type 2 diabetes were higher in those with a shorter time interval between the diagnosis of type 2 diabetes and RA.ConclusionsThis large nationwide, population-based, case-control study showed an elevated risk of RA in female Taiwanese patients with type 2 diabetes. Our findings were consistent with the hypothesis that chronic low-grade inflammation in type 2 diabetes may elicit the development of RA in genetically susceptible individuals.
Highlights
The prevalence of type 2 diabetes has rapidly increased in many Asian populations, including the Taiwanese, thought to be the result of a combination of a sedentary lifestyle and unhealthy dietary habits
The annual incidence of Rheumatoid arthritis (RA) in Taiwan was 15.8 cases per 100,000 population with a female to male ratio of 4 to 1 [8]. Inflammatory mediators such as Creactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-a are frequently elevated in patients with type 2 diabetes [4,5] as well as in the sera of patients many years before the clinical onset of RA [9], suggesting a critical role in the immunopathogenesis of this disease
We identified 1,416 patients newly diagnosed with RA with a certificate of catastrophic illness as cases, and 7,080 non-RA controls frequency-matched for sex, 10-year age interval, and index year
Summary
This nationwide, population-based, case-control study used administrative data to identify 1,416 patients with RA (age $20 years) as cases and 7,080 controls that were frequency-matched for sex, 10-year age group, and year of catastrophic illness certificate application date (index year). All subjects were retrospectively traced back, up to 13 years prior to the index year, for their first diagnosis of type 2 diabetes. Logistic regression analysis was conducted to quantify the association between incident RA and type 2 diabetes
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