Abstract
Type 1 diabetes mellitus may be associated with many autoimmune diseases with the common autoimmune pathogenesis. We describe the case of a girl suffering from Type 1 diabetes mellitus and autoimmune Hashimoto's thyroiditis since the childhood and, due to the onset of Juvenile Idiopathic Arthritis during adolescence, for three years practiced therapy with an anti-TNF drug, etanercept . Currently her inflammatory markers are normal, arthritis is inactive and diabetes is well controlled. During the treatment with anti-TNF drug we observed a significative reduction of insulin dose, probably due to an increased tissue sensitivity secondary to the suppression of the activity of TNF-alpha. Several clinical trials that have evaluated the effect of immunomodulatory agents in diabetic patients, especially in those with recent onset of disease, were already performed but further studies of longer duration on a larger population are needed to assess the role of biologic drugs and immunotherapy in this group of patients.
Highlights
The coexistence of Juvenile Idiopathic Arthritis (JIA) with Type 1 Diabetes Mellitus (T1DM) and Autoimmune Hashimoto's Thyroiditis (AHT) may be considered rare and it suggests a common genetic susceptibility [1,2]
We describe the case of a female patient suffering since the childhood from T1DM and AHT and in therapy with insulin and L-tiroxine, who developed JIA during adolescence unresponsive to conventional therapy with Non Steroid Anti Inflammatory Drugs (NSAIDs) and
A recent randomized, double blind, placebo controlled trials has shown that etanercept appears to be well tolerated from children suffering from T1DM and that if administered within 4 weeks after the onset of diabetes would be able to preserve the function of pancreatic beta cells
Summary
The coexistence of Juvenile Idiopathic Arthritis (JIA) with Type 1 Diabetes Mellitus (T1DM) and Autoimmune Hashimoto's Thyroiditis (AHT) may be considered rare and it suggests a common genetic susceptibility [1,2]. We describe the case of a female patient suffering since the childhood from T1DM and AHT and in therapy with insulin and L-tiroxine, who developed JIA during adolescence unresponsive to conventional therapy with Non Steroid Anti Inflammatory Drugs (NSAIDs) and Methotrexate (MTX) for which we started anti-TNF therapy. The daily insulin requirement was reduced, probably due to an increased tissue sensitivity secondary to the suppression of activity of TNF-alpha. A small randomized pilot study has reported that this medication in addition to being safe and effective, would be able in patients with T1DM of recent onset to prolong endogenous insulin production suggesting the preservation of beta cell pancreatic function [4]. Several clinical trials that have evaluated the effect of immunomodulatory agents in diabetic patients, especially in those with recent onset of disease, were already performed [5,6], but further studies with a longer follow-up are needed to assess the effectiveness and safety of immunotherapy in this group of patients [5,6,7]
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