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January 24, 2005

Other

Question from Asia:

My daughter also has had rheumatoid arthritis for about 16 months. Her A1c is 5.4 and has been in the low 5s for about two years. Her arthritis is the worst it can be, RA+, and it is polyarticular. She is now on methotrexate tablets, 2.5 mg, eight tablets and 10 mg of prednisolne and Bextra. She was on Vioxx for a year, but was taken off it in September. Her arms relaxed and seemed to have the RA under control, but they have locked up again and we have gone back to same amount of medication. She did well for maybe a month. The new therapy by the rheumatologist is injectable methotrexate or Etanercept and Hydroxychloroquine. How will this interact with the diabetes? Are the two diseases going to fight for dominance? I cannot find an endocrinologist or other doctor willing to think outside of the box and to do research. I have done a lot on my own, but only understand a third of what I am reading. I understand there was a study done last year that says that diabetics on insulin could have a problem getting the methotrexate to work.

Answer:

You don’t say where you are from, but there are many excellent diabetologists who can assist you with such questions. In a general sense, when treated with steroids like prednisone, the prednisone will interfere with insulin action and thus raise the blood glucose levels. This happens very predictably and is also dose related — the higher the prednisone dose needed for the arthritis, the more extra insulin will be needed. Most of the problems with diabetes management can be identified with blood glucose testing. You should go back and ask your diabetes team for a specific consultation visit and perhaps also send them a list of your questions ahead of time so that they can think about them. There are not likely to be a lot of specific answers since the two conditions are very rare together. You may also want to have the rheumatologists and the diabetologists consult, if this is not also done. Sometimes, your primary care provider, such as your family doctor or general practitioner or pediatrician, can help facilitate such conferences.

SB