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. 2021 Jul 1;157(7):817-823.
doi: 10.1001/jamadermatol.2021.1805.

Association of Granuloma Annulare With Type 2 Diabetes, Hyperlipidemia, Autoimmune Disorders, and Hematologic Malignant Neoplasms

John S Barbieri  1 , Misha Rosenbach  1   2 , Olaf Rodriguez  1 , David J Margolis  1   3
Affiliations

Association of Granuloma Annulare With Type 2 Diabetes, Hyperlipidemia, Autoimmune Disorders, and Hematologic Malignant Neoplasms

John S Barbieri et al. JAMA Dermatol. .

Abstract

Importance: Although granuloma annulare (GA) has been associated with several other conditions, these studies have been limited by single-center designs and small sample sizes.

Objective: To evaluate whether there is an association between GA and type 2 diabetes, hyperlipidemia, autoimmune conditions, and hematologic malignant neoplasms, using a large population-based cohort study.

Design, setting, and participants: This retrospective cohort study conducted between January 1, 2016, and June 30, 2019, used deidentified data from the US Optum Clinformatics Data Mart Database. A total of 5137 patients with GA were matched by age and sex with up to 10 randomly selected controls (n = 51 169) with a diagnosis of a nevus or seborrheic keratosis.

Main outcomes and measures: Logistic regression was used to evaluate for potential associations between GA and diabetes, hyperlipidemia, autoimmune conditions, and hematologic malignant neoplasms. All analyses were adjusted for race/ethnicity, income, and educational level.

Results: This study included 5137 individuals with GA (3760 women [73.2%]; mean [SD] age, 57.7 [19.0] years) and 51 169 controls (37 456 women [73.2%]; mean [SD] age, 57.7 [19.0] years). Those with GA were more likely than controls to have baseline diabetes (1086 [21.1%] vs 6780 [13.3%]; adjusted odds ratio [aOR], 1.67; 95% CI, 1.55-1.80), hyperlipidemia (1669 [32.5%] vs 14 553 [28.4%]; aOR, 1.15; 95% CI, 1.08-1.23), hypothyroidism (727 [14.2%] vs 5780 [11.3%]; aOR, 1.24; 95% CI, 1.15-1.36), and rheumatoid arthritis (62 [1.2%] vs 441 [0.9%]; aOR, 1.34; 95% CI, 1.02-1.75). Those with GA were more likely to have incident diabetes (144 [2.8%] vs 1061 [2.1%]; aOR, 1.31; 95% CI, 1.10-1.57), hypothyroidism (41 [0.8%] vs 252 [0.5%]; aOR, 1.59; 95% CI, 1.14-2.22), systemic lupus erythematosus (21 [0.4%] vs 65 [0.1%]; aOR, 3.06; 95% CI, 1.86-5.01), and rheumatoid arthritis (26 [0.5%] vs 122 [0.2%]; aOR, 2.05; 95% CI, 1.34-3.13). There was no association between GA and an increased risk of hematologic malignant neoplasms.

Conclusions and relevance: This population-based cohort study identified associations between GA and baseline diabetes and hyperlipidemia as well as between GA and both baseline and incident autoimmune conditions. These findings suggest that diabetes and hyperlipidemia may be risk factors for the development of GA and that autoimmunity may be an important factor in the pathogenesis of GA.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Rosenbach reported receiving personal fees from Merck, Janssen, Processa, and Eli Lilly; and grants from Processa outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Summary of Potential Associations Between Variables
Pathway 1 (blue lines): an underlying factor predisposes individuals to developing both the comorbidity and granuloma annulare. In this scenario, we would expect to find an association between granuloma annulare and both higher baseline prevalence and incidence of the comorbidity of interest. Pathway 2 (red line): the comorbidity predisposes individuals to developing granuloma annulare. In this scenario, we would expect to find an association between granuloma annulare and higher incidence of the comorbidity of interest. Pathway 3 (green line): granuloma annulare predisposes individuals to developing the comorbidity. In this scenario, we would expect to find an association between granuloma annulare and higher baseline prevalence of the comorbidity of interest.
See this image and copyright information in PMC

References

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