Unstable diabetes in a patient receiving anti-TNF-  for rheumatoid arthritis

Boulton, J.; Bourne, J. T.

doi:10.1093/rheumatology/kel322

Cited by 38 publications

(32 citation statements)

References 8 publications

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“…Several case reports, including our own, show a significant decrease in capillary blood glucose levels after anti-TNF-a therapy for concurrent inflammatory disorders in patients with DM. 7,8,14 Ours may be the first published case of a patient with insulin-dependent T2DM who, while on etanercept for psoriasis, had improvement in glycemic control. Yazdani-Biuki et al 8 reported a case of a patient with T2DM and psoriatic arthritis treated with infliximab who also experienced similar hypoglycemic events with eventual discontinuation of insulin.…”

Section: Discussionmentioning

confidence: 95%

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Persistent hypoglycemia in a patient with diabetes taking etanercept for the treatment of psoriasis

Cheung

Bryer‐Ash

2009

Journal of the American Academy of Dermatology

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Section: Discussionmentioning

confidence: 95%

“…14 Marra et al 15 found that after 24 weeks of treatment with etanercept, patients with psoriasis had improved insulin sensitivity as measured by the homeostasis model assessment index compared with baseline.…”

Section: Discussionmentioning

confidence: 99%

Persistent hypoglycemia in a patient with diabetes taking etanercept for the treatment of psoriasis

Cheung

Bryer‐Ash

2009

Journal of the American Academy of Dermatology

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“…In accordance with that, another study in 40 obese subjects with metabolic syndrome suggested that treatment with etanercept improves insulin sensitivity [56]. In addition, there have been isolated reports of diabetic patients with psoriasis or rheumatoid arthritis who developed unpredictable hypoglycaemia during treatment with etanercept [57,58]. There have been no studies investigating the effects of adalimumab on insulin resistance in psoriatic patients.…”

Section: Management Of Patients With Moderate To Severe Psoriasis Andmentioning

confidence: 87%

Systemic therapy of psoriasis in diabetic patients

Gisondi¹,

Perazzolli²,

Giglio³

et al. 2015

Glob Dermatol

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Psoriasis is a chronic inflammatory skin disease affecting 2-3% of worldwide population. Moderate to severe psoriasis is frequently associated with metabolic disorders including diabetes, obesity, dyslipidaemia, metabolic syndrome and non-alcoholic fatty liver disease. In particular, the prevalence of diabetes in patients with psoriasis ranges from 5 to 54%. Most of the studies found that the prevalence of diabetes is higher in patients with moderate to severe psoriasis compared to mild disease. The association between psoriasis and diabetes could be explained considering several factors including a common genetic background, the high prevalence of metabolic risk factors for diabetes in patients with psoriasis as well as unhealthy life-styles such heavy drinking, over-eating and sedentary, which are common in patients with psoriasis. From a clinical prospective, the understanding of the patients in the context of metabolic comorbidities including diabetes is very important to ensure that treatment is tailored to meet the individual patient needs. Indeed, some pharmacological treatments may negatively affect metabolic comorbidities, and have important interactions with drugs that are commonly used to treat them. Non-pharmacological intervention such as diet and physical exercise could both improve the response to treatments for psoriasis and reduce the risk of diabetes and cardiovascular events.

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“…Age appropriate cancer screening as per national guidelines if not previously performed (AR) IV Hold or delay bDMARDs in patients with active cancer while receiving chemotherapy or radiotherapy (CRA) IV TNF-α inhibitors are not recommended or should be used with caution in patients with treated lymphoma (CRA, ACR) 97 III Consider rituximab in patients with treated lymphoma (CRA, ACR) IV Patients with a treated solid cancer >5 years earlier may receive a bDMARD (ACR) or these drugs may be used with caution (CRA) [98][99][100] II Interstitial lung disease Patients should have PFT with DLCO and consultation with a pulmonologist before starting bDMARDs 101 IV Chronic obstructive pulmonary disease (COPD) TNF-α inhibitors recommended 102 II Avoid abatacept in patients with symptomatic COPD 103 II Diabetes bDMARDs recommended 104 105 II Monitor patients with brittle diabetes who start a TNF-α inhibitor for hypoglycemia 106 III Pregnancy bDMARDs not recommended during pregnancy (EMA) IV Given the absence of evidenced based data a discussion between patient, obstetrician, and rheumatologist is recommended before planning a pregnancy 107 III *Abbreviations: AR=authors' recommendations; ACR=2012 update of the American College of Rheumatology recommendations; CRA=Canadian Rheumatology Association recommendations for the pharmacological management of rheumatoid arthritis; DLCO=diffusion capacity of the lung for carbon monoxide; EMA=European Medicines Agency approved summary of product characteristics; EULAR=European League Against Rheumatism; PFT=pulmonary function tests; TNF-α=tumor necrosis factor α. †Levels of evidence I=meta-analyses, systematic reviews of randomized controlled trials (RCTs), or individual RCTs; II=meta-analysis of systemic reviews of observational studies, case control studies; III=case series and case reports; IV=expert opinion.…”

Section: Cancermentioning

confidence: 99%

How to use biologic agents in patients with rheumatoid arthritis who have comorbid disease

Richards

Dowell

Quinones

et al. 2015

BMJ

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Although biologic disease modifying anti-rheumatic drugs (bDMARDs) have improved the quality of life of patients with rheumatoid arthritis, side effects remain a problem, especially for patients with pre-existing comorbidities. Randomized controlled trials of such drugs in rheumatoid arthritis typically exclude patients with comorbidities and are of short duration, so they do not provide data on adverse events in these people. Other data sources such as national bDMARD registries are limited by the preselection of patients for both conventional synthetic chemical compound disease modifying anti-rheumatic drugs (csDMARDs) and bDMARDs, and although these databases document comorbidity, they rarely report its severity. This too limits definitive statements on the progression or resolution of pre-existing disease. Although bDMARDs may not be contraindicated in patients with rheumatoid arthritis and certain comorbid diseases, additional assessments or precautions are recommended. This review summarizes current data on the use of bDMARDs in people with rheumatoid arthritis and common comorbid diseases. It provides an evidence base for doctors and their patients when discussing and selecting the appropriate bDMARDs.

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Unstable diabetes in a patient receiving anti-TNF- for rheumatoid arthritis

Cited by 38 publications

References 8 publications

Persistent hypoglycemia in a patient with diabetes taking etanercept for the treatment of psoriasis

Persistent hypoglycemia in a patient with diabetes taking etanercept for the treatment of psoriasis

Systemic therapy of psoriasis in diabetic patients

How to use biologic agents in patients with rheumatoid arthritis who have comorbid disease

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