Association between Diabetes and Rheumatoid Arthritis: A Systematic Literature Review

Jad Okais1, Fouad Fayad1, Rafic Baddoura1, Ouidade Aitisha Tabesh2, Krystel Aouad1, Marcelle Ghoubar3, *, Nancy Sunna3, Eduardo Mysler4
1 Department of Rheumatology, Hotel Dieu de France University Hospital, Saint Joseph University, School of Medicine, Achrafieh, Beirut, Lebanon
2 Department of Rheumatology, Bellevue Medical Center, Beirut, Lebanon
3 Pfizer, Inflammation and Rare Diseases, Lebanon Awkar, Beirut, Lebanon
4 Organización Medica de Investigación, Buenos Aires, Argentina

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© 2022 Okais et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Pfizer, Inflammation and Rare Diseases, Lebanon Awkar, Beirut, Lebanon; E-mail:



To examine the risk of diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and whether the risk is related to conventional risk factors, RA disease activity, and treatment.


A systematic literature review (SLR) query was conducted using specified MeSH terms, searching PubMed and EMBASE databases from inception to March 2020. Both cohort or case-control design studies assessing the incidence or prevalence of DM in RA patients were included.


Of the 1948 articles, 43 peer-reviewed observational studies were selected. A high degree of heterogeneity in study design and reporting was observed, precluding final conclusions.

Based on the studies included, it was observed that DM prevalence ranged between 1% and 20% in RA patients, which was similar to controls (1–29%). The cumulative incidence of DM in RA patients ranged between 1.3% and 11.7% over different time frames. DM incidence rates in patients with RA per 1000 person-years ranged from 5.2 to 16.7.

RA patients may be at higher risk of DM, particularly among those receiving glucocorticoids (GC), while patients on hydroxychloroquine and biological disease-modifying anti-rheumatic treatments (DMARDs) may be at lower risk.


DM incidence may be increased in patients with RA as a result of more concomitant traditional risk factors and GC exposure. It is unclear whether biologics may have a true protective effect or provide a GC-sparing effect. High-quality studies in large cohorts of RA patients with appropriate adjustment for covariates are warranted to fully investigate the interplay between DM and RA.

Keywords: Rheumatoid arthritis, Risk factors, Diabetes mellitus, Comorbidity, Hyperglycemia, Treatment, Systematic review.