Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Glucocorticoid use linked to mortality in RA with diabetes

Key clinical point: Glucocorticoid use may be riskier in patients with RA and comorbid diabetes.

Major finding: Glucocorticoid use was associated with 44.9 more deaths per 1,000 person-years in those with RA and diabetes, and 34.4 more deaths in RA alone.

Study details: A retrospective analysis of U.K. primary care records (n = 9,085).

Disclosures: The study was funded by the Centre for Epidemiology Versus Arthritis and the National Institute for Health Research Biomedical Research Centre. Dr. Starkebaum has no relevant financial disclosures. Dr. Smith is on the speaker’s bureau for AbbVie and serves on the company’s advisory board. He is also on the advisory boards of Regeneron and Sanofi Genzyme.

Commentary

“Glucocorticoid therapy is essential for many patients with RA in order to control their symptoms—during flares or initiation or change of therapy, for example. Because glucocorticoids can cause hyperglycemia, we are especially cautious in their use in patients with diabetes. This British retrospective cohort study looks at mortality in RA patients with or without diabetes after treatment with glucocorticoids. The study is limited by use of diagnosis codes and prescription data but shows a significantly higher risk of death from all causes and from cardiovascular disease in RA patients with and without diabetes who were treated with glucocorticoids. The study also does not allow for assessment of the effects of glucocorticoid dose, nor a comparison of the impact of a prior diabetes diagnosis vs steroid-induced diabetes. The size of the effect appears to be greater in RA patients with diabetes, but the fact that glucocorticoids appear to worsen mortality risk in RA patients without diabetes also leaves the question open as to whether this finding is a marker of the severity of the RA requiring glucocorticoids.”

Arundathi Jayatilleke, MD

Lewis Katz School of Medicine, Temple University

Citation:

Costello R et al. BMC Rheumatol. 2020 Feb 19. doi: 10.1186/s41927-019-0105-4.