Abstract
Abstract: :
Purpose: Purpose: There appears to exist a "special" subgroups of the diabetic population (in both IDDM and in NIDDM) in which the simultaneous presence of a severe arthritic condition is present and may possibly provide long-term protection from development of diabetic vascular changes. We investigated this potential "protective factor" effect over a 12-84 months follow-up (ave. 38.7 mos) and the use of anti-inflammatory medications in some of these patients and potential correlation of medication use and this protective effect. Methods: Methods:We compare the retinal appearance for the presence of retinal disease in two groups of patients. Group One consisted of 54 patients, age 31-96 (ave. 64.9 yrs) who have had diabetes 26 yrs (IDDM 12-61yrs, ave 28.4 yrs.; NIDDM 10-38 yrs, ave. 18.2 yrs.) and some form of arthritis. Group One was age and duration of disease matched with Group Two, which had diabetes alone. All patients underwent careful biomicroscopy and indirect ophthalmoscopy by a retinal specialist with photographic documentation of the retinal appearance to detect evidence of DR. Results: Results: 95% of the patients in Group Two had developed severe non-proliferative and/or proliferative disease. This was the expected result supported by the literature, which suggests that virtually all insulin dependent diabetics of 20 or more years will manifest diabetic retinopathy. By comparison, 51 of the 54 patients in Group One (94.4%) had no detectable retinopathy, and 3/54 had transient macular edema which resolved. Interestingly, these 3 patients had recently been started on anti-inflammatory medications when the retinopathy "broke through". Conclusions: Conclusion: This special group of patients, with co-existing diabetes and arthritis may have an endogenous "protective factor." With long term observation as some patients use anti-inflammatory medications it is possible they may in someway "inhibit" some of this protective effect. Further investigation is warranted.
Keywords: diabetic retinopathy • autoimmune disease • neovascularization