Rheumatoid arthritis is somewhat of a medical mystery. Doctors believe that genetics influence the development of the disorder, but environmental factors, i.e. habits and activities within the patient’s control, may determine whether someone at risk does or does not develop RA. Genetic First, let us look at the genetic component of RA. People with rheumatoid arthritis have been found to have antibodies in their systems called anti-citrullinated protein/peptide antibodies (ACPAs for short). These antibodies, which attack the patient’s own proteins, signal the presence of RA. ACPAs are the most reliable predictor of RA. Another genetic marker of RA risk is the “rheumatoid factor.” The rheumatoid factor is also an antibody that shows up in patient blood work, but it is present in only eighty percent of actual rheumatoid arthritis patients. Both the rheumatoid factor and ACPAs can be accurately assessed with a blood test. Family History Anyone with a close family member who has developed rheumatoid arthritis should assume that he or she is at risk unless a blood test has clearly shown the absence of ACPAs and the rheumatoid factor. However, it is important to note that not everyone with ACPAs will develop rheumatoid arthritis. Age Age and gender play an important role.

In treating rheumatoid arthritis, the aim is to reduce pain, retain the maximum mobility, and slow the progress of the disease. At the same time, those who treat RA patients must bear in mind that medications used in the treatment of this disorder often cause serious health problems by themselves. Risks must be carefully and precisely weighed against benefits. Patients should, in particular, take the minimum medication needed to control pain and inflammation, taking care, not to overdose. Medications To slow down the progress of rheumatoid arthritis, doctors prescribe disease-modifying antirheumatic drugs (DMARDS). There are two classes of such drugs. First generation DMARDS are hydroxychloroquine, sulfasalazine, methotrexate, and leflunomide. Newer drugs, called “biologic agents,” include abatacept, adalimumab, anakinra, certolizumab, etanercept, and several others. A typical treatment regime will pair a biologic agent with one of the first generation DMARDS. Non-steroidal anti-inflammatory drugs (NSAIDS) are the preferred medications for day-to-day pain management. Many of these drugs are available without a prescription. The Mayo Clinic recommends ibuprofen (available as Advil and Motrin) and naproxen sodium (available as Aleve) in the daily treatment of pain association with RA. Patients who take ibuprofen on a daily basis must be monitored for signs of kidney, liver, and heart failure.

Patients with diabetes have a higher risk of developing heart disease than non-diabetic patients. According the the American Heart Association diabetic patients are 3x more likely to develop heart disease then non-diabetic and nearly 60-68% of patients with diabetes will die from heart disease. In addition, diabetic patients develop coronary artery disease (a condition that affects the blood vessels the supply the heart with blood) at a younger age than those without diabetes. The reason for this is because people with diabetes not only have higher blood sugar, but often have other conditions that increase risk for heart disease such as elevated blood pressure, high cholesterol, and being overweight. Proper blood pressure, blood sugar, and cholesterol management along with a healthy lifestyle can can help reduce risk. Risk factors for developing heart disease in patients with Diabetes: men >50 years women >60 years family HX CVD hypertension (blood pressure >130/80) smoking high cholesterol albuminuria (protein in the urine)

Acanthosis nigricanis: A darkening and thickening in the folds of the skin; typically found on neck, armpit, groin. Described as brown velvety feeling patches Benign condition Mostly found on overweight patients May be reduced by weight loss and glucose control Onychomyosis: Fungal infection of the nails Thickening, flaking, splitting of the nails Yellowing of the nails Require antifungal treatment for 12 weeks or longer Diabetic Foot Ulcer: Breakdown of skin due to decreased blood perfusion Superficial wound that may extend down to the bone Most common reason for hospitalization among diabetic patients Is the leading cause of non traumatic foot amputation Prevention is key Smoking, high blood sugar, high blood pressure, and high cholesterol increases risk Diabetic Dermopathy: Are spots on the skin due to changes in small blood vessels cause leakage of blood products into surrounding tissue Most often found on the shins, which is why they are sometimes called shin spots Associated with standing for long periods of time and blood poor glucose control Typically heal/ improve on their own with good  blood glucose control

Diabetic Retinopathy is damage to the blood vessels of the retina due to chronic elevation in blood sugar. It is very important diabetic patients have yearly eye exams due to increased risk for vision impairments. Symptoms: Early in this disease patients may not experience any symptoms, but over time the following can occur Decreased vision blurry vision Floaters (specks or squiggles that enter your line of vision) Distorted vision Dulling of color Prevention: Yearly eye exams Keep blood sugar under control: There is a 30% reduction in risk per 1% of A1c decreased Blood pressure control: <130/80 Complications: Complications associated with diabetic retinopathy: Blindness Glaucoma Retinal Detachment