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S. A. Skolik, L. E. Caspers; Less Retinopathy Is Seen in Arthritic-Diabetic Patients Compared to Patients With Diabetes Alone. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2763. doi: https://doi.org/.
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To compare the diabetic retinopathy seen in long-term diabetic patients with and without co-existing clinical arthritis and the evaluate use of aspirin, presence of hypertension and level of HgA1C. Also, to investigate if the order of onset of diabetes and arthritis relative to each other is important in the subsequent retinopathy that develops or fails to develop.
A retrospective chart review identified 117 arthritic-diabetic patients (Group One) and these were matched with non-arthritic diabetics (Group Two) from the same general patient population for age, race, length and type of diabetes. Group One to Group Two: age 29-91 (av. 68.1) vs 33-89 (av.65.4), race %Caucasian 97.4 vs 99.1, years diabetes 20-54 (av 27.8) vs 20-5( av.26.2) and matched for type1 or type 2 diabetes. Inclusion in the "clinical arthritis" group was determined from patient self identification and/or previous physician diagnosis. Subgroups of arthritis were identified including Osteoarthritis (n= 78), Rheumatoid Arthritis (n=13), Gout (n=11), Temporal arthritis (n=4), Sarcoidosis (n=3), Irritable Bowel Syndrome (n=2), Lupus (n=1), Unknown (n=5). Laboratory data to support clinical diagnoses used when available. Relative disease onset: Diabetes first (n=39), Arthritis first (n=13), Simultaneous onset (n=60). A complete ophthalmic examination was completed and fundus photography was obtained. A masked retinal specialist graded the level of retinopathy of each patient using the modified Early Treatment of Diabetic Retinopathy Scale.
Group One developed less PDR than Group Two 12% vs 95.5% (P<0.0001), Any retinopathy (NPDR+/-PDR) was also less likely in Group One 24.8% vs 100% (P<0.001) Onset of Arthritis prior to or simultaneous with Diabetes had only 1.7% develop PDR. No significant difference found in use of aspirin (32.5% vs 30.8%), presence of hypertension (67.5% vs 63.4%), or level of HgA1c (7.49+/-1.52 vs 7.56+/-1.33).
Arthritic-Diabetics appear to have endogenous protection from development of the same level of retinopathy as their non-arthritic counterparts, especially if the onset of arthritis precedes or is simultaneous with onset of the diabetes.
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