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S. A. Skolik, L. E. Caspers; The Occurrence of Proliferative Diabetic Retinopathy in Long-Term Diabetic Patients With or Without Co-Existing Clinical Arthritis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5068.
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To determine the occurrence of proliferative diabetic retinopathy in long-term diabetic patients (patients with diabetes of twenty years of duration or longer) with and without clinical arthritis.
A retrospective review of charts of patients with 20 or more years of diabetes mellitus and with arthritis (group "A/DM") seen between January 1996 and August 2009 identified 117 patients. These patients were matched with patients with diabetes mellitus but without arthritis (group "NoA/DM") from the same patient population for age, race, duration and type of diabetes. Years of diabetes A/DM v NoA/DM was 20-54 (mean 27.8) v 20-56 (mean 26.2). In each group, 73 persons had type-I and 44 had type-II Diabetes Mellitus. Clinical arthritic symptom onset was determined. Retinopathy was graded in a masked fashion from fundus photographs using ETDRS criteria. Patient referral patterns were also examined as well as chronic use of aspirin or NSAIDs and level of hyperglycemic control, presence of hypertension or history of smoking.
The two groups showed no significant difference in glycosylated hemoglobin, chronic aspirin use, history of smoking or hypertension. Fewer persons in the A/DM group developed proliferative diabetic retinopathy (PDR) than in the NoA/DM group, 14(12.0%) v 111(94.9%) (p<0.0001). PDR developed in 1of 73 (1.4%) patients who had arthritis onset prior to or the same year as their diabetes onset, compared to 11of 39 (28.2%) diabetic patients who subsequently developed arthritis (p<0.0001). Referral patterns were similar in the two groups as was use of NSAIDs.
Arthritic diabetic patients with symptomatic clinical arthritis appeared protected from developing retinopathy compared to non-arthritic diabetic patients, especially when the onset of arthritis preceded or began the same year as their diabetes. Investigation for protective immune products of inflamed synovium that retard leukocyte adhesion is suggested. Use of neither aspirin nor NSAID appears to alter this protection.
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