Background Patients with rheumatoid arthritis (RA) have increased cardiovascular (CV) and mortality risk. Patients with RA are also frequently prescribed glucocorticoids (GCs) which have been associated with increased risk of mortality. In addition, for patients who have concomitant diabetes mellitus (DM), GCs are known to worsen glycaemic control and hence may further increase CV and mortality risk. This study aimed to understand the relationship between GCs, DM and mortality in patients with RA. Methods This was a retrospective cohort study of patients with incident RA identified from UK primary care electronic medical records. Patients with linkage to Office for National Statistics (ONS) for mortality data (N = 9085) were included. DM was identified through Read codes, prescriptions and blood tests, and GC use was identified through prescriptions. Mortality rate ratios (RR) and rate differences (RD) were calculated across the different exposure groups. Cox proportional hazards regression models were used to estimate interaction on the multiplicative and additive scales. Results In those without DM GC use had a 4.4-fold increased all-cause mortality RR (95% confidence interval (CI): 3.83 to 5.14) compared to non-use, whilst those with DM had a lower RR for GC use (3.02 (95% CI: 2.34, 3.90)). However, those with DM had a higher RD associated with GC use because of their higher baseline risk. In those with DM, GC use was associated with an additional 46.7 deaths/1000 person-years (pyrs) (95% CI: 34.1 to 59.3) compared to non-use, while in those without DM GC use was associated with an additional 36.2 deaths/1000 pyrs (95% CI: 31.6 to 40.8). A similar pattern was seen for CV mortality. The adjusted Cox proportional hazards model showed no evidence of multiplicative interaction, but additive interaction indicated a non-significant increased risk. For CV mortality there was no interaction on either scale. Conclusions GC use was associated with higher mortality rates in people with comorbid DM compared to people without DM, despite apparently reassuring similar relative risks. Clinicians need to be aware of the higher baseline risk in patients with DM, and consider this when prescribing GCs in patients with RA and comorbid DM.

中文翻译：

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糖皮质激素治疗对类风湿性关节炎合并 II 型糖尿病患者死亡率的影响：一项回顾性队列研究。

背景 类风湿性关节炎 (RA) 患者的心血管 (CV) 和死亡风险增加。RA 患者也经常服用糖皮质激素 (GC)，这与死亡风险增加有关。此外，对于合并糖尿病 (DM) 的患者，已知 GC 会恶化血糖控制，因此可能进一步增加 CV 和死亡风险。本研究旨在了解 RA 患者的 GC、DM 和死亡率之间的关系。方法 这是一项针对从英国初级保健电子病历中识别出的 RA 事件患者的回顾性队列研究。包括与国家统计局 (ONS) 联系以获得死亡率数据的患者 (N = 9085)。DM 是通过阅读代码、处方和血液测试确定的，GC 的使用是通过处方确定的。计算不同暴露组的死亡率比 (RR) 和死亡率差异 (RD)。Cox 比例风险回归模型用于估计乘法和加法尺度上的相互作用。结果 在没有使用 GC 的 DM 患者中，与不使用相比，全因死亡率 RR 增加了 4.4 倍（95% 置信区间 (CI)：3.83 至 5.14），而使用 GC 的 DM 患者的 RR 较低（3.02 （95% 置信区间：2.34、3.90））。然而，由于基线风险较高，DM 患者与 GC 使用相关的 RD 较高。在患有 DM 的人群中，与不使用 GC 相比，使用 GC 与额外的 46.7 例死亡/1000 人年 (pyrs)（95% CI：34.1 至 59.3）相关，而在没有 DM 的人群中，使用 GC 与额外的 36.2死亡数/1000 pyrs（95% CI：31.6 至 40.8）。CV 死亡率也有类似的模式。调整后的 Cox 比例风险模型未显示乘法相互作用的证据，但加法相互作用表明风险增加不显着。对于 CV 死亡率，两种量表均无交互作用。结论 与没有 DM 的人相比，GC 的使用与合并症 DM 患者的死亡率更高相关，尽管显然相对风险相似。临床医生需要意识到 DM 患者的基线风险较高，并在为 RA 和共病 DM 患者开 GCs 处方时考虑这一点。结论 与没有 DM 的人相比，GC 的使用与合并症 DM 患者的死亡率更高相关，尽管显然相对风险相似。临床医生需要意识到 DM 患者的基线风险较高，并在为 RA 和共病 DM 患者开 GCs 处方时考虑这一点。结论 与没有 DM 的人相比，GC 的使用与合并症 DM 患者的死亡率更高相关，尽管显然相对风险相似。临床医生需要意识到 DM 患者的基线风险较高，并在为 RA 和共病 DM 患者开 GCs 处方时考虑这一点。