Background/Purpose: Hydroxychloroquine (HCQ) is widely prescribed for patients with Rheumatoid Arthritis (RA) and Systemic Lupus Erythromatus (SLE). It is fairly well tolerated with multiple well studied side effects, including those on insulin homeostasis and glucose metabolism. In this study, we review the long term effects of HCQ on blood glucose control in patients with RA and Impaired Glucose tolerance (Pre-DM) or Diabetis (DM).

Methods: 155 patients with RA who were prescribed HCQ from Jan, 2014 to Jan, 2017 were identified. These patients were grouped into patients HgbA1c ranging from 5.7 to 6.4 as Pre-DM and those with HgbA1c >6.4 as DM. HgbA1c levels 6 months prior to initiation of therapy was identified and compared to HgbA1c levels 6 months and 1 year after the initiation of HCQ. We also compared LDL levels of these patients 1 year prior to and 1 year after the initiation of HCQ.

Results:

• 19 patients were identified as DM. 17 (89%) patients had a repeat HgbA1c at 6 months of which 12 (70%) had improvement and 5 (30%) had worsening. The average improvement in HbA1c in all these patients was 1.46% at 6 months. 17 patients had HgbA1c at 1 year. Of them, 11 (64%) had improvement, 5 (22%) had worsened and 1 (6%) had no change. The average improvement in HbA1c in all these patients was 2.62% at 1 year. These patients were on different combination of diabetes medications.
• 25 patients were identified as PreDM prior to start of therapy. Of these, 11 patients (44%) had a HgbA1c at 6 months, 9 (81%) of them showed improvement and 3 (19%) showed worsening. The average improvement in HbA1c in all these patients at 6 months was 0.33%. 9 patients had followed up HgbA1c at 1 year after their HCQ therapy. Of them, 7 (77%) showed improvement while 2 (12%) had similar and 2 (11%) patient had worsening of their HgbA1c. The average improvement in HbA1c at 1 year was 0.29%. None of these patients were on any form of glucose control medication.
• We also reviewed 58 patients with LDL levels approximately 6 months prior to and 1 year after treatment with HCQ. 30 (51%) patients showed a decrease and 28 (49%) showed an increase in their LDL level.

Conclusion:

HCQ has been shown to reduce the risk of development of DM in patients with RA. Studies have also shown reduction of HgbA1c in patients with RA and DM on treatment. HCQ also improves glucose control in patients with DM without any rheumatologic disease. This has been postulated to be from its effect on increased insulin secretion and decreased degradation leading to insulin accumulation at cellular level increasing their insulin sensitivity and this is independent of its anti-inflammatory activity.Our study suggests the positive effect of HCQ on average blood glucose levels represented by the drop in HgbA1c by 2.62% in DM patient and a drop of 0.29% in the PreDM group of patients. This favorable effect of HCQ on glucose control could makes it a preferred anti-inflammatory in those patients that have RA along with PreDM or DM.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/favorable-effect-of-hydroxychloroquine-in-patients-with-rheumatoid-arthritis-and-diabetes-or-impaired-glucose-control/