Case Report Of A Child With Recently Diagnosed Diabetes Mellitus Type 1 And Subsequent Systemic Arthritis

Abstract

“Clustering” of autoimmune disorders is relatively common. Reports exist of concomitant insulin-dependent diabetes mellitus (DM1) and juvenile idiopathic arthritis (JIA). However there are few reports about coexistence of DM1 and the systemic subtype of JIA (sJIA), and even fewer documenting the chronological onset of DM1 before sJIA. In most reports, DM1 developed after therapy for preexisting sJIA. There is debate about whether those therapies played a causative role in the manifestation of DM1. Herein we describe an 11-year old male not receiving any such therapy who was diagnosed with DM1 one month prior to receiving a second diagnosis of sJIA. His diabetes necessitated an early taper of prednisone, and he was started on a regimen of daily anakinra (Interleukin-1 blocker). Afterwards, the patient experienced breakthrough inflammatory symptoms. He restarted a progressively lower dose of oral prednisone, which controlled his symptoms. In an effort to understand the rare instance of encountering these two diseases in one patient, we undertook a literature search to examine the possibility of a common etiology, with special focus on variations along the inflammatory cascade of the immune system, including the alleles encoding perforin and interleukin-6 (IL-6).