The use of DMARDs may be associated with different levels of diabetes risk in RA patients

Patients with rheumatoid arthritis (RA) are more prone to diabetes than the general population, leading to an elevated risk of cardiovascular disease. A study featured in RMD Open indicates that the level of diabetes risk in patients with RA can vary depending on the treatment they receive. The researchers noted that RA patients undergoing combination therapy or biologics exhibit a lower risk of diabetes compared to those on methotrexate monotherapy. 

The study, conducted by a group of Taiwanese researchers, utilized data from the Chang Gung research database (CGRD) and involved 5530 adults with RA but no diabetes. Between 2001 and 2018, a total of 546 subjects (9.87%) developed diabetes, according to the study’s findings. The researchers reported that the risk of developing diabetes was significantly reduced during the treatment periods involving biologic disease-modifying anti-rheumatic drugs (bDMARDs) (HR 0.51; 95% CI 0.32-0.83), MTX combination therapy (HR 0.50; 95% CI 0.32-0.78), and other cDMARDs (HR 0.56; 95% CI 0.37-0.84) compared to MTX alone. Furthermore, an examination of each treatment individually revealed that hydroxychloroquine decreased the likelihood of developing diabetes, and tumor necrosis factor-α (TNF-α) inhibitors seemed to have a protective effect. 

Desai et al. revealed that the initiation of abatacept, when compared to infliximab or adalimumab, was associated with a reduced incidence of incident Diabetes mellitus (DM) in individuals with RA. In another study by Lillegraven et al., it was reported that patients using TNF-α inhibitors had a significantly lower risk of developing diabetes compared to those taking non-biologic DMARDs, except for hydroxychloroquine and methotrexate. According to a systematic review by Wondafrash et al., hydroxychloroquine may exhibit antidiabetic effects. The majority of the included studies showed significant improvements in lipid profiles and insulin levels, along with notable reductions in hemoglobin A1c, fasting plasma glucose, and postprandial blood glucose levels. 

Since cardiovascular events are the primary cause of morbidity in RA patients, informed decisions regarding medication choices must be made early to mitigate the development of diabetes. Based on the findings presented, it is prudent to consider the use of bDMARDs or combination therapy with cDMARDs as viable strategies to reduce the risk of DM and improve overall health outcomes in individuals with RA. 


  1. Su YJ, Chen HM, Chan TM, Cheng TT, Yu SF, Chen JF, et al. Disease-modifying anti-rheumatic drugs associated with different diabetes risks in patients with rheumatoid arthritis. RMD Open. 2023 Jul;9(3):e003045.
  2. Desai RJ, Dejene S, Jin Y, Liu J, Kim SC. Comparative Risk of Diabetes Mellitus in Patients With Rheumatoid Arthritis Treated With Biologic or Targeted Synthetic Disease-Modifying Drugs: A Cohort Study. ACR Open Rheumatol. 2020 Apr;2(4):222–31. 
  3. Lillegraven S, Greenberg JD, Reed GW, Saunders K, Curtis JR, Harrold L, et al. Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis. PLoS One. 2019;14(1):e0210459. 
  4. Wondafrash DZ, Desalegn TZ, Yimer EM, Tsige AG, Adamu BA, Zewdie KA. Potential Effect of Hydroxychloroquine in Diabetes Mellitus: A Systematic Review on Preclinical and Clinical Trial Studies. J Diabetes Res. 2020;2020:5214751.