CHARACTERISTICS OF THE CLINICAL COURSE OF RHEUMATOID ARTHRITIS IN PATIENTS WITH DIABETES MELLITUS
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Rheumatoid arthritis (RA) and diabetes mellitus (DM), particularly type 2 DM, are chronic inflammatory diseases whose co-occurrence presents a significant clinical challenge. This article reviews the specific characteristics of RA in patients with DM. The comorbidity is relatively common and driven by shared pathophysiological mechanisms, primarily chronic inflammation mediated by pro-inflammatory cytokines such as TNF-α and IL-6, which contribute to both insulin resistance and joint destruction. The clinical course of RA in diabetic patients is characterized by atypical symptom presentation (masked pain due to neuropathy), a complex overlap of arthropathies, and a markedly increased risk for severe complications, including accelerated cardiovascular disease, osteoporosis, infections, renal impairment, and ocular damage. Diagnosis is complicated by the confounding effects of hyperglycemia on inflammatory markers and imaging findings. Effective management requires a multidisciplinary approach prioritizing strict glycemic control, careful selection of antirheumatic drugs with consideration of their metabolic effects, and aggressive prophylaxis against cardiovascular and skeletal complications. Early detection, individualized treatment, and coordinated care among specialists are crucial for improving outcomes and quality of life in this high-risk patient population.
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