Type 2 diabetes mellitus, glycaemic control, associated therapies and risk of rheumatoid arthritis: a retrospective cohort study

Association Between T2DM, TyG Index, Multiple Sclerosis, and Rheumatoid Arthritis: Insights into Potential Mechanisms

Abundant research indicates that type 2 diabetes mellitus (T2DM) and insulin resistance (IR) have a certain association with autoimmune-related diseases (ARDs). However, the conclusions remain elusive. Therefore, this study aimed to explore whether there are causal associations between T2DM and IR indicator, triglyceride-glucose (TyG) index with ARDs, and evaluate the impact of immune cells. Comprehensive Mendelian randomization (MR) analysis combined with Bayesian colocalization was employed to investigate the relationship between T2DM, TyG index, ARDs, and specific-marker immune cells by extracting summary-level data from various genome-wide association studies (GWASs). Further investigations utilizing single-cell RNA sequencing (scRNA-seq) analysis were performed to explore the potential molecular mechanisms underlying the MR analysis results. Causal associations of T2DM with multiple sclerosis (MS) and rheumatoid arthritis (RA) were detected. Additionally, the TyG index was genetically predicted to be associated with MS. Furthermore, immune cells were found to be related to T2DM and TyG index, of which CD3 on naive CD8 + T cell mediate the effect on the association between TyG index and multiple sclerosis (MS). Additionally, genetic variation of TCF7L2 and TNFSF13B were assessed to play a crucial role in the aforementioned associations supported by colocalization analysis. This study identified T2DM and IR related to increased risk of MS and RA. The analysis of relevant immune cells and shared genetic loci provides a novel direction for exploring comorbidity mechanisms.

Association between vertebral fractures and comorbidities in patients with rheumatoid arthritis: a cross-sectional study

INTRODUCTION

Patients with rheumatoid arthritis (RA) are at an increased risk of osteoporosis and vertebral fractures. We investigated the risk factors for vertebral fractures and severe vertebral fractures in patients with RA, including comorbidities and urinary pentosidine levels.

MATERIALS AND METHODS

This study included 637 patients with available clinical data on urinary pentosidine levels, vertebral fractures, and comorbidities. Vertebral fractures were evaluated using plain X-ray imaging. Comorbidities considered relevant to osteoporosis were type 2 diabetes mellitus, chronic kidney disease, and lung diseases.

RESULTS

The prevalence of vertebral fractures in this cohort was 30.1%. Patients with vertebral fracture Patients with vertebral fractures were significantly more likely to be older [odds ratio (OR) 1.075; 95% confidence interval (CI) 1.049-1.1.03], had higher prevalence of comorbidities (OR 1.770; 95% CI 1.138-2.753), higher urinary pentosidine levels (OR 1.028; 95% CI 1.013-1.044), higher history of non-vertebral fractures (OR 2.084; 95% CI 1.222-3.557), and lower total hip T-score (OR 0.526; 95% CI 0.329-0.841) than patients without vertebral fractures. Among patients with vertebral fractures, 54.2% had severe vertebral fractures. Patients with severe vertebral fractures were more likely to have lower lumbar spine T-scores (OR 0.768; 95% CI 0.622-0.949) than patients with non-severe vertebral fractures.

CONCLUSIONS

This study identified factors associated with vertebral fractures and severe vertebral fractures in patients with RA. Notably, vertebral fractures were associated with comorbidities and urinary pentosidine levels. In patients with RA and vertebral fractures, low BMD in the lumbar spine was a significant factor associated with severe vertebral fractures.

Causal association of metformin treatment with diverse immune-mediated inflammatory diseases: A Mendelian randomization analysis

Metformin has been shown to possess immune-modulating and anti-inflammatory effects in various animal and clinical studies. It is believed to be effective in treating some immune-mediated inflammatory diseases (IMIDs). However, there remains ongoing debate regarding the extent to which metformin can reduce the risk of developing IMIDs. We used the data from genome-wide association studies to explore the causal relationship between metformin treatment and some IMIDs through the Mendelian randomization (MR) analysis. Additionally, sensitivity analyses were performed using the Cochran Q-test, MR-PRESSO and "leave-one-out" to confirm the robustness of our conclusions. The MR analysis indicated that metformin treatment could reduce the risk of rheumatoid arthritis (RA) (OR = 0.018, 95% CI: 1.33 × 10-3-0.233, P = .002), multiple sclerosis (MS) (OR = 0.966, 95% CI: 0.936-0.997, P = .030) and primary sclerosing cholangitis (PSC) (OR = 6.82 × 10-4, 95% CI: 7.83 × 10-6-5.93 × 10-2, P = .001). But metformin treatment is not significantly associated with the risk of Crohn disease (OR = 0.994, 95% CI: 0.979-1.009, P = .431), ulcerative colitis (UC) (OR = 0.987, 95% CI: 0.965-1.009, P = .234), systemic lupus erythematosus (SLE) (OR = 164.373, 95% CI: 0.158-1.71 × 105, P = .150), autoimmune hepatitis (AIH) (OR = 2.909, 95% CI: 4.58 × 10-3-1.85 × 103, P = .746) and primary biliary cholangitis (PBC) (OR = 0.055, 95% CI: 1.44 × 10-3-2.112, P = .119). Due to the heterogeneity of the data from UC, SLE, MS, and PBC, we adjusted them. After adjustment, there is no change in the results for UC, SLE, MS, and PBC. The findings of this study support metformin treatment may reduce the risk of RA, MS, and PSC.

Metformin Treatment Reduces the Incidence of Rheumatoid Arthritis: A Two-Sample Mendelian Randomized Study

Several studies have shown that rheumatologic patients can benefit from metformin, but it remains unclear whether metformin treatment is causally associated with the risk of rheumatoid arthritis (RA). A two-sample Mendelian randomization (MR) study was conducted to investigate the causal relationship between metformin treatment and the incidence of rheumatoid arthritis. The genome-wide significant (p < 5 × 10^-8) single-nucleotide polymorphisms (SNPs) associated with metformin use were selected as instrumental variables (IVs). Summary statistics on RA were extracted from a large genome-wide association study (GWAS) meta-analysis. The inverse variance-weighted (IVW) method was used as the determinant of the causal effects of metformin treatment on RA. Cochran's Q was used to detect heterogeneity. Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) test and MR-Egger regression were used to detect horizontal pleiotropy. A total of 34 SNPs significantly associated with metformin treatment were obtained. Thirty-two SNPs were selected as IVs after removing two SNPs for being palindromic with intermediate allele frequencies (rs11658063 and rs4930011). The IVW results showed a negative causal association between metformin treatment and RA (OR = 0.0232, 95% CI 1.6046 × 10^-3 - 0.3368; p = 0.006). Meanwhile, no heterogeneity or pleiotropy was detected, indicating that the results were reliable. This study indicated a negative causality between metformin treatment and RA, indicating that the treatment of metformin can prevent the pathogenesis of RA.

Novel insight into the aetiology of rheumatoid arthritis gained by a cross-tissue transcriptome-wide association study

BACKGROUND

Although genome-wide association studies (GWASs) have identified more than 100 loci associated with rheumatoid arthritis (RA) susceptibility, the causal genes and biological mechanisms remain largely unknown.

METHODS

A cross-tissue transcriptome-wide association study (TWAS) using the unified test for molecular signaturestool was performed to integrate GWAS summary statistics from 58 284 individuals (14 361 RA cases and 43 923 controls) with gene-expression matrix in the Genotype-Tissue Expression project. Subsequently, a single tissue by using FUSION software was conducted to validate the significant associations. We also compared the TWAS with different gene-based methodologies, including Summary Data Based Mendelian Randomization (SMR) and Multimarker Analysis of Genomic Annotation (MAGMA). Further in silico analyses (conditional and joint analysis, differential expression analysis and gene-set enrichment analysis) were used to deepen our understanding of genetic architecture and comorbidity aetiology of RA.

RESULTS

We identified a total of 47 significant candidate genes for RA in both cross-tissue and single-tissue test after multiple testing correction, of which 40 TWAS-identified genes were verified by SMR or MAGMA. Among them, 13 genes were situated outside of previously reported significant loci by RA GWAS. Both TWAS-based and MAGMA-based enrichment analyses illustrated the shared genetic determinants among autoimmune thyroid disease, asthma, type I diabetes mellitus and RA.

CONCLUSION

Our study unveils 13 new candidate genes whose predicted expression is associated with risk of RA, providing new insights into the underlying genetic architecture of RA.

Sulfonylureas or biguanides is associated with a lower risk of rheumatoid arthritis in patients with diabetes: A nationwide cohort study

Objective

Diabetes mellitus (DM) is associated with immune dysregulation, while sulfonylureas or biguanides have been linked to anti-inflammatory mechanisms. In this study, we aimed to examine the occurrence rate of rheumatoid arthritis (RA) among DM patients and its incidence rate between different treatments.

Methods

This cohort study used the Taiwan National Health Insurance Research Database between 1997 and 2013 to evaluate the primary outcomes of the preventive role of sulfonylureas or biguanides in the development of RA. We used the Chi-square test for categorical variables and Cox proportional hazard regression and log-rank test to explore the time for development of RA in DM patients. Logistic regression was adopted to estimate the odds ratio of RA in different dosages of medication exposure.

Results

Our cohort study included 94,141 DM cases. The risk of RA development of non-sulfonylureas/biguanides users among the DM group in each analysis was set as the reference, and the adjusted hazard ratio of RA in DM patients who were using sulfonylureas or biguanides was 0.73 (95% confidence interval 0.60–0.90). Within 1 year before the index date, compared with no-biguanides users, patients with more than 180 days of prescription of biguanides had a significantly lower RA risk. Similarly, the significantly lower risk of RA was still observed in DM patients who had more than 365 days of prescription of sulfonylurea within 2 or 3 years before the index date of first RA visit (all p &lt; 0.05).

Conclusion

Our data suggest that sulfonylureas or biguanides are associated with a lower rate of RA development in patients with DM; the effect of biguanides appeared more rapid than that of sulfonylureas, but the sulfonylureas might have a longer effect on lowering RA development incidence.

Incident Rheumatoid Arthritis Following Statin Use: From the View of a National Cohort Study in Korea

Safety issues regarding the potential risk of statins and incident rheumatoid arthritis (RA) have been raised, but the existing data are largely based on Caucasian populations, and continue to have biases and require further validation in Asian populations. Here, we aimed to verify the risk of RA depending on the duration of previous statin use and statin types using a large-scale, nationwide database. This study enrolled 3149 patients with RA and 12,596 matched non-RA participants from the national health insurance database (2002−2015), and investigated their statin prescription histories for two years before the index date. Propensity score overlap-weighted logistic regression was applied after adjusting for multiple covariates. The prior use of any statins and, specifically, the long-term use of lipophilic statins (>365 days) were related to a lower likelihood of developing RA ((odds ratio (OR) = 0.73; 95% confidence intervals (CI) = 0.63−0.85, p < 0.001) and (OR = 0.71; 95% CI = 0.61−0.84, p < 0.001), respectively). Subgroup analyses supported these preventive effects on RA in those with dyslipidemia, independent of sex, age, smoking, alcohol use, hypertension, and hyperglycemia. Hydrophilic statin use or short-term use showed no such associations. Our study suggests that prior statin use, especially long-term lipophilic statin use, appears to confer preventive benefits against RA.