Incidence of diagnosed Type 1 diabetes continues to increase in Israel at a rate that is high compared with similar American and European populations. At the same time, the clinical presentation of children is changing.

Our results indicate that T1D occurring in toddlers is characterized with a relatively low incidence of viral disease 2 yr prior to diagnosis and a much higher incidence in the subsequent year.

BackgroundRheumatoid arthritis (RA) is an autoimmune, symmetrical polyarticular disease characterised by chronic inflammation of the synovial joints. Microalbuminuria (MA) occurs as a leakage of small amounts of albumin into the urine. Metabolic syndrome (MetS) describes risk factors for cardiovascular diseases such as dyslipidaemia, obesity, hypertension and diabetes.ObjectivesThe aim of this study is to detect the prevalence of MA in patients with RA and study its correlation with disease activity and severity. Our aim extends to identify the association of MA with MetS in rheumatoid arthritisMethodsThis study was carried out on 30 adult RA patients, 30% male patients and 70% female patients (mean ±SD 42.27±10.99 years). Their mean disease duration was 12.8±7.06 years. Twenty apparently healthy adults of matched age and sex served as a control group. All the patients were subjected to full history taking, full clinical examination, laboratory investigations and assessment of disease activity using DAS 28 Score. Urinary microalbumin level was measured in all subjects in early morning samples by the immunoturbidometry method. MetS was assessed in all subjects according to Grundy’s criteria.ResultsThe RA patients’ group had highly significantly (p<0.001) elevated mean values of urinary microalbumin and urinary albumin to creatinine ratio compared to the control group (63.9±2.57 mg/dl vs 21.95±13.88 mg/dl, 46.6±35.28 ug/mg vs 14.9±11.45 ug/mg respectively).The frequency of the metabolic syndrome according to Grundy’s criteria was 60% in the RA patients’ group. This frequency was highly statistically significant (p<0.001) compared to the control group (10%). The MetS was prevalent in 13/15 (87%) of RA patients with microalbuminuria (MA), while 5 normo-albuminuric RA patients (33%) had the MetS. A statistically significant difference was observed among these groups (p<0.05). On the other hand, 13/18 (72%) of RA patients with MetS had MA.Although RA patients with MA had and increased mean values of disease duration, body mass index, waist circumference, fasting blood sugar, triglycerides, high density lipoprotein, DAS 28 and Larsen’s score, they had no statistically significant differences compared to normo-albuminuric patients.RA patients with the MA had a statistically significantly higher mean disease duration (p=0.004) than patients without the MetS. There were highly statistically significant positive correlations (p<0.001) of urinary microalbumin levels with disease duration, duration of morning stiffness, number of tender joints, number of swollen joints, ESR 1st hour, C-reactive protein, Larsen’s score, DAS 28, and A/CR.ConclusionsMA and MetS are frequent in RA, particularly in those with long standing disease. Early detection of albuminuria allows early intervention with the goal of reducing inflammation development in RA, CV risk. MetS is frequent in RA patients with MA.Reference[1] Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome. ...