Italian Journal of Pediatrics | |
Refractory rheumatoid factor positive polyarthritis in a female adolescent already suffering from type 1 diabetes mellitus and Hashimoto’s thyroiditis successfully treated with etanercept | |
Laura Perrone1  Francesco Prisco1  Maria Francesca Gicchino1  Carmela Granato1  Angela Mauro1  Angela Zanfardino1  Antonio Mellos1  Dario Iafusco1  Alma Nunzia Olivieri1  | |
[1] Department of the Woman, of the Child and of the General and Specialistic Surgery, Second University of Naples (SUN), 2, via Luigi De Crecchio, Naples 80138, Italy | |
关键词: Etanercept; Anti-TNF therapy; Tumor necrosis factor; Immunotherapy; Autoimmunity; Rheumatoid factor; Polyarthritis; Juvenile idiopathic arthritis; Autoimmune Hashimoto's thyroiditis; Type 1 diabetes mellitus; | |
Others : 812495 DOI : 10.1186/1824-7288-39-64 |
|
received in 2013-07-02, accepted in 2013-10-06, 发布年份 2013 | |
【 摘 要 】
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.
【 授权许可】
2013 Olivieri et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20140709085129848.pdf | 450KB | download | |
Figure 2. | 66KB | Image | download |
Figure 1. | 68KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
【 参考文献 】
- [1]Nagy KH, Lukacs K, Sipos P, Hermann R, Madacsy L, Soltesz G: Type 1 diabetes associated with Hashimoto's thyroiditis and juvenile rheumatoid arthritis: a case report with clinical and genetic investigations. Pediatr Diabetes 2010, 11(8):579-582.
- [2]Pohjankoski H, Kautiainen H, Kotaniemi K, Korppi M, Savolainen A: Autoimmune diseases in children with juvenile idiopathic arthritis. Scand J Rheumatol 2010, 39(5):435-436.
- [3]Barker JM: Clinical review: type 1 diabetes-associated autoimmunity: natural history, genetic associations, and screening. J Clin Endocrinol Metab 2006, 91(4):1210-1217.
- [4]Mastrandrea L, Yu J, Behrens T, Buchlis J, Albini C, Fourtner S, Quattrin T: Etanercept treatment in children with new-onset type 1 diabetes: pilot randomized, placebo-controlled, double-blind study. Diabetes Care 2009, 32(7):1244-1249.
- [5]Schneider DA, Kretowicz AM, von Herrath MG: Emerging immune therapies in type 1 diabetes and pancreatic islet transplantation. Diabetes Obes Metab 2013, 15(7):581-592.
- [6]Chen W, Xie A, Chan L: Mechanistic basis of immunotherapies for type 1 diabetes mellitus. Transl Res 2013, 161(4):217-229.
- [7]Peters MJ: Etanercept treatment in children with new-onset type 1 diabetes: pilot randomized, placebo-controlled, double-blind study: response to Mastrandrea et al. Diabetes Care 2009, 32(12):e153. author reply e154
- [8]Cacciari E, Milani S, Balsamo A, Spada E, Bona G, Cavallo L, Cerutti F, Gargantini L, Greggio N, Tonini G, Cicognani A: Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). J Endocrinol Invest 2006, 29(7):581-593.
- [9]Marshall WA, Tanner JM: Variations in pattern of pubertal changes in girls. Arch Dis Child 1969, 44(235):291-303.
- [10]Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P: International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004, 31(2):390-392.
- [11]Beukelman T, Patkar NM, Saag KG, Tolleson-Rinehart S, Cron RQ, DeWitt EM, Ilowite NT, Kimura Y, Laxer RM, Lovell DJ, Martini A, Rabinovich CE, Ruperto N: 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken) 2011, 63(4):465-482.
- [12]Kemper AR, Van Mater HA, Coeytaux RR, Williams JW Jr, Sanders GD: Systematic review of disease-modifying antirheumatic drugs for juvenile idiopathic arthritis. BMC Pediatr 2012, 15:12-29.
- [13]Cronstein B: How does methotrexate suppress inflammation? Clin Exp Rheumatol 2010, 28(5 Suppl 61):S21-S23.
- [14]Insel RA: Delivering on George Eisenbarth's visionary pursuit of understanding pathogenesis and prevention of type 1 diabetes. Diabetes Technol Ther 2013, Suppl 2:S2-4-S2-7.
- [15]Eisenbarth GS: Type I diabetes mellitus. a chronic autoimmune disease. N Engl J Med 1986, 314(21):1360-1368. Review
- [16]Luo X, Herold KC, Miller SD: Immunotherapy of type 1 diabetes: where are we and where should we be going? Immunity 2010, 32(4):488-499.
- [17]Spain LM, Martey L, Akolkar B, Leschek E, Appel M, Fradkin J: NIH research to prevent type 1 diabetes: George Eisenbarth's legacy. Diabetes Technol Ther 2013, 15 Suppl 2:S2-1-S2-3.
- [18]Bloom BJ: Development of diabetes mellitus during etanercept therapy in a child with systemic-onset juvenile rheumatoid arthritis. Arthritis Rheum 2000, 43(11):2606-2608.
- [19]Boulton JG, Bourne JT: Unstable diabetes in a patient receiving anti-TNF-alpha for rheumatoid arthritis. Rheumatology (Oxford) 2007, 46(1):178-179.
- [20]Bonilla E, Lee YY, Phillips PE, Perl A: Hypoglycaemia after initiation of treatment with etanercept in a patient with type 2 diabetes mellitus. Ann Rheum Dis 2007, 66(12):1688.
- [21]Arif S, Cox P, Afzali B, Lombardi G, Lechler RI, Peakman M, Mirenda V: Anti-TNF alpha therapy-killing two birds with one stone? Lancet 2010, 375(9733):2278.
- [22]Cheung D, Bryer-Ash M: Persistent hypoglycemia in a patient with diabetes taking etanercept for the treatment of psoriasis. J Am Acad Dermatol 2009, 60(6):1032-1036.
- [23]Tack CJ, Kleijwegt FS, Van Riel PL, Roep BO: Development of type 1 diabetes in a patient treated with anti-TNF-alpha therapy for active rheumatoid arthritis. Diabetologia 2009, 52(7):1442-1444.
- [24]Montes VN, Hirsch IB: Treatment of LADA with etanercept. Diabetes Care 2012, 35(5):e36.
- [25]Michels AW, Nakayama M: The anti-insulin trimolecular complex in type 1 diabetes. Curr Opin Endocrinol Diabetes Obes 2010, 17(4):329-334.