摘要 ：目的：旨在評估類風濕關節炎(RA)患者中糖尿病的發病率及糖尿病對自身健康狀況的整體影響。
方法：從全國法定健康保險基金隨機選取18歲至79歲年齡段的RA患者，並對其進行隨訪調查有關風濕病診治及疾病負擔方麵的情況。根據年齡、性別、BMI及社會經濟學狀態分析合並疾病糖尿病的相關情況。比較RA合並與RA不合並糖尿病患者之間在疾病負擔、伴隨疾病和用藥方麵的差異。通過多元回歸分析確定風濕病治療的預測因素。
結果：在2535例RA患者中有498例(20%)患者合並了糖尿病。糖尿病尤為多見於男性、老年、高BMI以及社會經濟狀況低下的患者群體。在RA合並糖尿病的患者中患者的預後均不好，且主要可能與高BMI有關。RA合並糖尿病患者較單純RA患者接受更少的DMARDs和住院天數也更多。RA合並糖尿病的患者中心血管疾病、抑鬱和腎衰竭的發生率更高。經混雜因素校正後，RA合並糖尿病患者更少接受風濕病專科醫生的治療(57% vs 67%)。
結論：RA患者中糖尿病的發生率很高，且與已知的社會經濟學因素有關。超過40%的RA合並糖尿病的患者並沒有接受風濕科專業醫生的診治，盡管研究提示這部分患者的疾病負擔很高、經常住院和通常有更多的合並症。
附原文：Abstract Objectives: To investigate the prevalence ofdiabetes in patients with RA and the impact of diabetes on self-reportedoutcomes and health care. Methods: RA patients between the ages of 18 and 79years were randomly selected from a nationwide statutory health insurance fundand were surveyed about rheumatological care and disease burden. Comorbiddiabetes (E10-14) was analysed regarding age, sex, BMI and socioeconomicstatus. Disease burden, comorbidity and prescriptions were compared in RApatients with and without diabetes. Predictors of rheumatological care wereidentified by multivariate regression. Results: Of the 2535 RA patients, 498(20%) had diabetes. Diabetes was more frequent in males, in older patients, in patientswith a higher BMI and in those with a lower socioeconomic status. All diseaseoutcomes were poorer in RA-diabetes patients and were mainly attributable to ahigher BMI. RA-diabetes patients received less DMARDs (40% vs 48%) and had morehospital stays (41% vs 30%) than patients without diabetes (all P < 0.05).Rates of cardiovascular disease (35% vs 15%), depression (39% vs 26%) and renalfailure (23% vs 8%) were higher in RA-diabetes patients (all P < 0.0001).They were less frequently treated by rheumatology specialists: 57% vs 67%; oddsratio = 0.64 (95% CI: 0.45, 0.92), after controlling for confounders. Conclusion:The prevalence of diabetes in patients with RA is high and is associated withknown sociodemographic factors. More than 40% of patients with RA and diabeteswere not under rheumatological care even though they reported a high diseaseburden, were frequently hospitalized and often presented with furthercomorbidities.
引自：Albrecht K,Luque Ramos A,Hoffmann F,Redeker I,Zink A. High prevalence of diabetes in patients withrheumatoid arthritis: results from a questionnaire survey linked to claimsdata.Rheumatology (Oxford).2018 Feb 1;57(2):329-336. doi:10.1093/rheumatology/kex414.
