Monitoring Diabetes In Patients With And Without Rheumatoid Arthritis: A Medicare Study
Abstract Diabetes mellitus is a key predictor of mortality in rheumatoid arthritis (RA) patients. Both RA and diabetes increase the risk of cardiovascular disease (CVD), yet understanding of how comorbid RA impacts the receipt of guideline-based diabetes care is limited. The purpose of this study was to examine how the presence of RA affected hemoglobin A1C (A1c) and lipid measurement in older adults with diabetes. Using a retrospective cohort approach, we identified beneficiaries ≥65 years old with diabetes from a 5% random national sample of 2004 to 2005 Medicare patients (N = 256,331), then examined whether these patients had comorbid RA and whether they received guideline recommended A1c and lipid testing in 2006. Multivariate logistic regression was used to examine the effect of RA on receiving guideline recommended testing, adjusting for baseline sociodemographics, comorbidities and health care utilization. Two percent of diabetes patients had comorbid RA (N = 5,572). Diabetes patients with comorbid RA were more likely than those without RA to have baseline cardiovascular disease (such as 17% more congestive heart failure), diabetes-related complications including kidney disease (19% higher), lower extremity ulcers (77% higher) and peripheral vascular disease (32% higher). In adjusted models, diabetes patients with RA were less likely to receive recommended A1c testing (odds ratio (OR) 0.84, CI 0.80 to 0.89) than those without RA, but were slightly more likely to receive lipid testing (OR 1.08, CI 1.01 to 1.16). In older adults with diabetes, the presence of comorbid RA predicted lower rates of A1c testing but slightly improved lipid testing. Future research should examine strategies to improve A1c testing in patients with diabetes and RA, in light of increased Continue reading >>
Juvenile Idiopathic Arthritis (jia, Arthritis In Childhood, Juvenile Rheumatoid Arthritis, Jra, Juvenile Chronic Arthritis)
ENBREL is a medicine that affects your immune system. ENBREL can lower the ability of your immune system to fight infections. Serious infections have happened in patients taking ENBREL. These infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections. Your healthcare provider should test you for TB before you take ENBREL and monitor you closely for TB before, during, and after ENBREL treatment, even if you have tested negative for TB. There have been some cases of unusual cancers reported in children and teenage patients who started using tumor necrosis factor (TNF) blockers before 18 years of age. Also, for children, teenagers, and adults taking TNF blockers, including ENBREL, the chances of getting lymphoma or other cancers may increase. Patients with RA may be more likely to get lymphoma. Before starting ENBREL, tell your healthcare provider if you: Have any existing medical conditions Think you have, are being treated for, have signs of, or are prone to infection. You should not start taking ENBREL if you have any kind of infection, unless your healthcare provider says it is okay Were born in, lived in, or traveled to countries where there is more risk for getting TB. Ask your healthcare provider if you are not sure Live, have lived in, or traveled to certain parts of the country (such as, the Ohio and Mississippi River valleys, or the Southwest) where there is a greater risk for certain kinds of fungal infections, such as histoplasmosis. These infections may develop or become more severe if you take ENBREL. If you don’t know if these infections are common in the areas you’ve been to, ask your healthcare provider Are taking anti-diabetic medicines H Continue reading >>
Arthritis & Diabetes
What do diabetes and arthritis have in common? Plenty. People with diagnosed diabetes are nearly twice as likely to have arthritis, indicating a diabetes-arthritis connection. Diabetes occurs when the body does not produce or use the hormone insulin sufficiently. Insulin shuttles glucose from foods into cells so it can be converted into energy. Without insulin, glucose remains in your blood (raising blood glucose levels), your cells create less energy and you feel fatigued. What starts off as a hormonal problem can evolve into joint problems, in addition to the widely known cardiovascular problems. Diabetes causes musculoskeletal changes that lead to symptoms such as joint pain and stiffness; swelling; nodules under the skin, particularly in the fingers; tight, thickened skin; trigger finger; carpal tunnel syndrome; painful shoulders; and severely affected feet. After having had diabetes for several years, joint damage – called diabetic arthropathy – can occur. Continue reading >>
Fri0117 Diabetes In Rheumatoid Arthritis: Incidence And Association With Ra Treatment
Abstract Background Studies indicate that different RA-treatments are associated with a decreased risk of type 2 diabetes mellitus (DM), a strong risk factor for cardiovascular disease in the general population.ion. Objectives To estimate the incidence rate and standardized morbidity ratio (SMR) of DM in RA, and to assess the influence of RA-treatment on DM risk in RA. Methods We identified RA-patients participating in a longitudinal prospective observational study of rheumatic diseases in the US from 2000 through 2010. All were diagnosed by a rheumatologist and completed at least two semi-annual questionnaires. DM was determined by patient self-report or use of any DM-specific medication. Patients with DM at enrollment were excluded from analyses. Participants provided all treatments taken. SMRs were estimated using the Centers for Disease Control and Prevention reported incidence rate of DM for the US stratified by calendar year, sex and age. Cox proportional hazard models were used to estimate hazard ratios (HR) to compare the 6-month lagged association of treatment with DM risk. Adjustments were made for baseline age, sex, RA-duration, ethnicity, employment status, total income, smoking status, comorbidity index, HAQ and body mass index (BMI). Results In total, 10,853 RA-patients were included with 695 (6.4%) having DM during followup.At baseline, mean (SD) RA duration was 13.6 (11.3) years and age was 59.5 (13.2) years. Baseline mutually exclusive treatment groups included 24.6% on at least hydroxychloroquine (HCQ), 30.0% on methotrexate (MTX) alone or with TNF-inhibitor, and 42.4% on other or no DMARDs. The incidence rate (95% CI) for DM was 1.34 (1.2-1.5) per 100 person-years, and the corresponding SMR was 1.2 (1.1-1.3). After adjustments, the only individual tre Continue reading >>
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Unstable Diabetes In A Patient Receiving Anti-tnf-α For Rheumatoid Arthritis
S ir , Tumour necrosis factor-α (TNF-α) is a cytokine well-recognized as having a significant role in the inflammatory process. Recent advances have led to the production of drugs that inhibit the action of TNF-α, producing significant improvement in the control of rheumatic diseases [ 1 ]. TNF-α may also play a role in other physiological processes. Prolonged administration of anti-TNF-α drugs is increasingly common in the treatment of rheumatic disease and also inflammatory bowel disease. Here we report on a case of an individual whose diabetes became unstable following the administration of anti-TNF drugs. Our case is a 55-yr-old female who has had type 1 diabetes since the age of 30. Aged 33, she developed rheumatoid arthritis. Having failed a number of disease-modifying anti-rheumatic drugs (DMARDs), she was commenced on etanercept (25 mg twice weekly) in April 2003 (DAS = 7.06). This led to significant improvement in her joints immediately. Having previously had stable diabetes, within 3 weeks of commencing the drug, she noticed that her blood sugars were erratic. She had a severe hypoglycaemic attack without warning, followed further by one more a few days later. After urgent clinical review, the etanercept was stopped and her glycaemic control stabilized. Despite commencing subcutaneous methotrexate, her joints remained markedly active, which ultimately led to her admission in October 2004. Her Disease Activity Score (DAS) score was 6.8, and after much consideration the patient was commenced on adalimumab. Within 12 h of administration, she developed severe hypoglycaemia, which recurred again 24 h later. The adalimumab was subsequently stopped. The patient has continued with severe active joint disease. She has had severe side effects with a number of DMARD Continue reading >>
Rheumatoid Arthritis And Diabetes: Are They Linked?
Rheumatoid arthritis (RA) and diabetes are very different diseases. But there's a connection between them. Having one may mean you're more likely to develop the other. In fact, research shows that RA raises your risk for diabetes by about 50%. And diabetes raises your risk of having arthritis, including RA and arthritis-related issues, by about 20%. Nearly half of American adults who have diabetes also have arthritis. Experts aren't sure why these two diseases are linked. They believe that a variety of things play a role, including: RA and type 1 diabetes are both autoimmune diseases. The immune system's job is to destroy germs and other sickness-causing invaders. Sometimes, the system goes haywire and turns against the body's own healthy cells. RA attacks the joints. Type 1 diabetes targets the cells in the pancreas that produce insulin, a hormone that helps your body process blood sugar. Type 1 diabetes is typically diagnosed in children and young adults and makes up less than 5% of all diabetes cases. Research suggests that some people tend to have more than one autoimmune disease. This may be partly due to genetics. And scientists have identified a gene that raises the risk for both type 1 diabetes and RA. RA causes chronic inflammation. In the short run, inflammation helps the body heal. But when it's ongoing, it causes the body to stop responding to insulin the way it should. This is called insulin resistance. Over time, the condition raises the risk for type 2 diabetes. This occurs when the body doesn't make enough insulin or resists its effects. Diabetes also triggers inflammation. On the flipside, chronic inflammation from diabetes may pave the way for RA. RA is caused by genetics and environmental factors. Research suggests that inflammation may cause people w Continue reading >>
Arthritis And Diabetes
Tweet Arthritis is the term for conditions which cause inflammation of the joints. There are more than 100 different forms of arthritis, with a broad range of causes. Some of these forms of arthritis have close associations with certain types of diabetes. Arthritis can usually be treated to help reduce symptoms and slow progression of the condition. How common is arthritis? Arthritis is common, with an estimated 10 million people living with the condition in the UK alone. Osteoarthritis is the most common form of arthritis, affecting around 8 million in the UK. Whilst arthritis is most commonly associated with the elderly, a number of forms or arthritis can affect people of any age, including children. Types of arthritis Whilst there are many dozen forms or causes of arthritis, the following are some of the more common forms: Osteoarthritis - caused by damage to the cartilage in the joints Rheumatoid arthritis - an autoimmune form of arthritis Gout - caused by a build up of uric acid Ankylosing spondylitis - a form which usually causes stiffness in the spine Reactive arthritis - can result from certain infections causing red swollen joints Secondary arthritis - may occur following joint injury Juvenile arthritis - forms of arthritis that affect children Arthritis and diabetes Certain forms of arthritis may be more common in people with certain types of diabetes. People with type 2 diabetes have higher risks of developing osteoarthritis and gout, which is likely on account of the fact that obesity increases the risk of type 2 diabetes as well as these forms of arthritis. People with type 1 diabetes have significantly higher risks of also having rheumatoid arthritis. Both conditions are autoimmune diseases and research suggests that certain genes may increase the risk of Continue reading >>
The Link Between Rheumatoid Arthritis And Diabetes
Having rheumatoid arthritis (RA) makes you about 50 percent more likely to develop type 2 diabetes than those without the autoimmune disease. Experts aren’t exactly sure what’s behind the connection, but many say that the link may be due to the inflammation that occurs with RA. “A lot of inflammation causes insulin resistance, which increases blood sugar levels,” says Scott Zashin, MD, a rheumatologist and clinical professor of medicine at the University of Texas Southwestern Medical School. Being sedentary because of RA pain further increases your risk for type 2 diabetes. And any steroid drugs you take for RA can make it harder to control blood sugar. “When you have a lot of steroids in your body, your body makes glucose because it assumes you’re going to need it for some kind of ‘fight or flight’ response,” says Wayne Evron, MD, an endocrinologist and medical director of the Joslin Diabetes Center in Pittsburgh. “But if you’re giving them to someone to control their RA, it can make their sugars higher.” The connection between type 2 diabetes and RA isn’t yet set in stone. “The data is kind of mixed,” Dr. Zashin warns. “There have been studies published showing an association between RA and diabetes, and some that haven’t shown an association.” Type 1 diabetes, which occurs when the body’s immune system attacks the pancreas, may also be a risk for people with RA. Though it used to be called juvenile diabetes, people can develop type 1 diabetes at any age. And because type 1 diabetes and rheumatoid arthritis are both autoimmune diseases, they can occur together. Dr. Evron explains that they may be prevalent in families that tend to get autoimmune diseases And researchers have recently identified a gene named PTPN22 that can increas Continue reading >>
Tampa Florida Rheumatoid Arthritis Diabetes Copd Lupus Treatment Trials Launched
Clinical Research of West Florida is enrolling participants for new research studies. Residents suffering from COPD, lupus, diabetes or rheumatoid arthritis can apply for medical care. CRWF offers qualified patients in Tampa, St Petersburg, and Clearwater world-class medical care, with no fees or insurance needed. A Tampa, Florida based clinical research center has launched a search for people suffering from COPD, lupus, diabetes and rheumatoid arthritis. Clinical Research of West Florida can offer qualified patients in Tampa, St Petersburg and Clearwater cutting-edge medical care, with no fees or medical insurance needed. More information can be found at: Clinical Research of West Florida (CRWF) has four trials ongoing today, investigating and evaluating new medications, procedures and/or devices for COPD, lupus, rheumatoid arthritis and diabetes. CRWF is looking for study participants that have been diagnosed with any of these diseases for its cutting-edge research. CRWF is the future of medicine in Tampa Bay, and has been providing medical care at no cost for more than 20 years. It has a world class facility with the best doctors, staff and administrators in the industry. Clinical Research of West Florida is on the cutting-edge of research, consistently finding new ways to prevent and treat a wide range of medical conditions for people. For local residents looking for medical care for COPD, lupus, diabetes and rheumatoid arthritis, there are a number of benefits to taking part in the studies. The advantages of enrolling for treatment at CRWF include minimal to no waiting times in comparison to other forms of healthcare. There are private, quiet treatment rooms, and there is no need for patients to have health coverage in order to enroll in a study. In addition to thi Continue reading >>
15 Surprising Facts About Rheumatoid Arthritis
Learning more about RA About 1.3 million people in the U.S., or 1% of adults, have rheumatoid arthritis. RA is different from osteoarthritis; it's caused by an abnormal immune reaction that attacks the lining of the joints and damages other parts of the body. More research is needed to shed light on RA's exact causes, which are thought to be a combination of genes and environmental factors. However, here are some surprising facts about what is known about RA's history, triggers, and risk factors. RA used to be a "wasting disease" In the past, people with RA were often rail-thin; exercise was thought to do further damage to the joints, so their muscles atrophied, says David Pisetsky, MD, professor of medicine and immunology at the Duke University Medical Center, in Durham, N.C. In addition, the chronic inflammation associated with RA causes weight loss and loss of appetite, he says. Today, medicines curb inflammation, and exercise is part of treatment—so RA doesn't have to mean wasting away. While exercise can be difficult (if not impossible) during a flare-up, activity is generally thought to help, not hurt, people with RA. Smoking may trigger RA Smoking is the most well-understood environmental trigger and may play a role in one-third of severe cases of RA, including more than 50% of RA diagnoses among people who are genetically susceptible to the disease. "Smokers who have a genetic variant known as shared epitope have a tenfold increased risk for developing RA," Dr. Pisetsky says. "We know smoking causes heart disease and certain cancers and many other diseases, but there is surprise about its link to RA." RA risk varies with geography The further you get from the equator, the higher your risk of RA. What's more, living at a higher latitude earlier in life—at age Continue reading >>
A Specific Association Exists Between Type 1 Diabetes And Anti-ccp Positive Rheumatoid Arthritis
Go to: Abstract The co-occurrence of autoimmune diseases such as rheumatoid arthritis (RA) and type 1 diabetes (T1D) has been reported in individuals and families. We studied the strength and nature of this association at the population level. We conducted a case-control study of 1419 incident RA cases and 1674 controls between 1996 and 2003. Subjects were recruited from university, public and private rheumatology units throughout Sweden. Blood samples were tested for the presence of antibodies to cyclic citrullinated peptide (anti-CCP), rheumatoid factor (RF) and the presence or absence of the 620W PTPN22 allele. Information on history of diabetes was obtained by questionnaire, telephone interview, and medical record review. The prevalence of T1D and type 2 diabetes (T2D) was compared between incident RA cases and controls and further stratified by anti-CCP, RF status, and the presence of the PTPN22 risk allele. T1D was associated with an increased risk of RA, OR 4.9 (95% CI 1.8–13.1), and was specific for anti-CCP+ RA, OR 7.3 (95% CI 2.7–20.0), but not anti-CCP negative RA. Further adjustment for PTPN22 attenuated the odds ratio for anti-CCP+ RA in individuals with T1D to 5.3 (95% CI 1.5–18.7). No association was observed between RA and T2D. The association between T1D and RA is specific for a particular RA subset, anti-CCP+ RA. The risk of type 1 diabetics developing RA later in life may be attributed in part to the presence of the 620W PTPN22 allele, suggesting a common pathway for the pathogenesis of these two diseases. Continue reading >>
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The Other Benefits Of Biologics
If you’re on a biologic medication to treat rheumatoid arthritis (RA) or psoriatic arthritis (PsA), here’s great news: Along with halting joint damage and relieving pain, research shows that biologics can improve your health in unexpected ways (a few studies are brand new!). And what if you’re not on a biologic? Well, if your current treatment is working, that’s great! But if it’s not, now’s the time to discuss all your options with your doctor. Consider that the right treatment may help you... Dodge heart trouble Controlling RA with a biologic may also protect your ticker—especially important news because RA is a risk factor for heart disease. Researchers who studied 14,000 patients found that those on a biologic had a lower risk of heart attack, likely due to the drug’s inflammation-fighting effects. Source: 2013 meeting of the American College of Rheumatology (ACR) Steer clear of diabetes A study of nearly 1,600 RA patients found that those who were using certain biologics were 51% less likely to develop diabetes in the next four years vs. patients using other types of disease-modifying drugs (DMARDs). That’s a significant benefit, since people with RA and PsA have a 50% higher risk of getting diabetes. Source: Arthritis Care & Research, Annals of the Rheumatic Diseases Ease depression Psoriasis patients on a biologic reported fewer depression symptoms and better skin improvement than those not using the drug, and experts suspect people with PsA would experience the same outcome. Study authors note that biologics suppress certain inflammatory chemicals associated with not only autoimmune diseases but also depression, a common problem for those with psoriasis and PsA. Source: Journal of the American Academy of Dermatology Fend off surgery Treating RA Continue reading >>
Poor Clinical Response In Rheumatoid Arthritis Is The Main Risk Factor For Diabetes Development In The Short-term: A 1-year, Single-centre, Longitudinal Study
Abstract Despite of the European League Against Rheumatism (EULAR) provided different sets of recommendations for the management of cardiovascular risk in inflammatory arthritis patients, it must be pointed out that cardiometabolic comorbidity, such as type 2 diabetes (T2D), remains still underdiagnosed and undertreated in patients affected by rheumatoid arthritis (RA). In this work, we designed a single centre, prospective study in order to better investigate the occurrence of T2D during the course of 1 year of follow-up. Furthermore, we evaluated the role of both traditional cardiovascular and RA-specific related risk factors to predict the occurrence of new T2D. Results In this study, we evaluated 439 consecutive RA patients and we observed that 7.1% of our patients (31/439) developed T2D, after 12 month of prospective follow-up. The regression analysis showed that the presence of high blood pressure, the impaired fasting glucose (IFG) at the first observation and the poor EULAR-DAS28 response, after 12 months of follow–up, were significantly associated with an increased likelihood of being classified as T2D. Similarly, we observed that 7.7% of our patients (34/439) showed IFG after 12 months of prospective follow-up. The regression analysis showed that the presence of high blood pressure and the poor EULAR-DAS28 response after 12 months of follow-up, were significantly associated with an increased likelihood of showing IFG. Our study supports the hypothesis of a significant short-term risk of T2D in RA patients and of a close associations between uncontrolled disease activity and glucose metabolism derangement. Further multicentre, randomised-controlled studies are surely needed in order to elucidate these findings and to better ascertain the possible contribution Continue reading >>
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Keeping Active With Diabetes And Arthritis
Daily physical activity is essential for good health and blood glucose control in people with diabetes. But what if you also have arthritis? One in five American adults has been diagnosed with arthritis, and half of all adults with diagnosed diabetes also have arthritis. Symptoms of arthritis can make it difficult to be active. But don’t let that stop you in your efforts: Frequent physical activity can help reduce the pain and stiffness of arthritis by improving muscle strength, endurance, and flexibility. Routine exercise also increases energy levels and helps with weight control. Other benefits include lowered blood pressure, a lower risk of heart disease, and sometimes improved sleep patterns. If you have arthritis as well as diabetes, it is important to keep your muscles as strong as possible, because the stronger the muscles and tissues are around the joints, the better they will support and protect those joints. When you don’t exercise, your muscles become weak and your bones become more brittle, which leads to a worsening of arthritis symptoms and to other health problems such as osteoporosis, the decrease in bone density that can lead to bone fractures. About arthritis The most common form of arthritis is osteoarthritis, in which cartilage in the joints deteriorates. Cartilage is the tough but flexible tissue that normally covers the ends of bones where they meet in a joint, allowing for easy movement. Over time, as cartilage deteriorates in an affected joint, the space between the bone ends may narrow, extra bits of bone may develop on the bone ends, and the joint may change shape. These changes can lead to friction, pain, stiffness, and further joint damage. Osteoarthritis often affects more than one joint, and while it can affect any joint in the body, so Continue reading >>
Recommended Diet For Rheumatoid Arthritis Patients
Adapting a healthy diet is the first strategy that should be implemented by rheumatoid arthritis patients, or anyone who wants to avoid this disease. It’s crucial that you nourish your body with a wide variety of high-quality, organic, and locally-grown whole vegetables. Apart from being rich in vitamins and minerals, vegetables are effective anti-inflammatories — perfect for rheumatoid arthritis patients. Adapting a healthy diet is the first strategy that should be implemented by rheumatoid arthritis patients, or anyone who wants to avoid this disease. Unfortunately, the majority of people today consume diets loaded with processed foods, grains, and sugars like fructose. Studies have shown links between constant consumption of sugar to disease like obesity, and chronic diseases like type 2 diabetes, Alzheimer's and heart disease. This is because sugar feeds pathogenic microbes and weakens the immune system. In fact, excessive sugar intake is linked to 76 negative effects to your health, such as increased risk of chronic degenerative diseases and autoimmune diseases (like RA), loss of tissue elasticity and function, and brittle tendons. These Are Essentials for Rheumatoid Arthritis Patients It's crucial that you nourish your body with a wide variety of high-quality, organic, and locally-grown whole vegetables. Apart from being rich in vitamins and minerals, vegetables are effective anti-inflammatories — perfect for rheumatoid arthritis patients. Some of the best choices include: • Sprouts: these vegetables, which have just sprung from the seeds, are more nutritious compared to their matured counterparts. Sprouts contain high amounts of vitamins, minerals, antioxidants, and enzymes, and protect your body from free radicals and toxic pollutants. Plus, you can choo Continue reading >>
