Hydroxychloroquine and glycemia in women with rheumatoid arthritis and systemic lupus erythematosus

Abstract

Objective: To determine the relationship between current hydroxychloroquine (HCQ) use and 2 indicators of glycemic control, fasting glucose and insulin sensitivity, in nondiabetic women with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA).

Methods: Nondiabetic women with SLE (n = 149) or RA (n = 177) recruited between 2000 and 2005 for a cross-sectional evaluation of cardiovascular risk factors were characterized by HCQ usage status. Unadjusted and multivariately adjusted mean fasting glucose, median insulin, and insulin resistance [assessed by the homeostasis model assessment (HOMA-IR) calculation] were compared among HCQ users and nonusers for disease-specific groups.

Results: More women with SLE were taking HCQ than those with RA (48% vs 18%; p < 0.0001; mean dose ~ 400 mg vs ~ 200 mg). For women with SLE or RA, after adjustment for age, waist circumference, disease duration, prednisone dosage, C-reactive protein, menopausal status, nonsteroidal antiinflammatory drugs, and disease-specific indicators, serum glucose was lower in HCQ users than in nonusers (SLE: 85.9 vs 89.3 mg/dl, p = 0.04; RA: 82.5 vs 86.6 mg/dl, p = 0.05). In women with SLE, HCQ use also was associated with lower (log)HOMA-IR (0.97 vs 1.12, p = 0.09); in those with RA, no differences in (log)HOMA-IR were seen. HCQ usage was not associated with fasting insulin levels in either patient group.

Conclusion: HCQ use was associated with lower fasting glucose in women with SLE or RA and also lower (log)HOMA-IR in the SLE group. The use of HCQ may be beneficial for reducing cardiovascular risk by improving glycemic control in these patients.