title: Refractory rheumatoid factor positive polyarthritis in a female adolescent already suffering from type 1 diabetes mellitus and Hashimoto's thyroiditis successfully treated with etanercept.
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.
authors.affiliation: 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. alma.olivieri@unina2.it.
authors.forename: Alma Nunzia
authors.initials: AN
authors.lastname: Olivieri
authors.forename: Dario
authors.initials: D
authors.lastname: Iafusco
authors.forename: Antonio
authors.initials: A
authors.lastname: Mellos
authors.forename: Angela
authors.initials: A
authors.lastname: Zanfardino
authors.forename: Angela
authors.initials: A
authors.lastname: Mauro
authors.forename: Carmela
authors.initials: C
authors.lastname: Granato
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Gicchino
authors.forename: Francesco
authors.initials: F
authors.lastname: Prisco
authors.forename: Laura
authors.initials: L
authors.lastname: Perrone
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology*; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis / Q000276:immunology*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D050031:Hashimoto Disease / Q000150:complications / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012217:Rheumatoid Factor / Q000097:blood*; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D012217:Rheumatoid Factor; D000068800:Etanercept