DPP-4 Inhibition in Diabetic Rheumatoid Arthritis Patients

ABSTRACT

Rheumatoid arthritis (RA) is a common disorder that affects the synovium with an autoimmune reaction. Additionally, the prevalence of diabetes mellitus (DM) in RA patients is higher compared with normal population. Chronic systemic inflammation is a characteristic feature of RA and also has been associated with both insulin resistance and type 2 DM. A recent research by Ospelt et al. showed that inhibition of fibroblast activation protein and dipeptidylpeptidase increases cartilage invasion by rheumatoid arthritis synovial fibroblasts. Furthermore, Jacobs et al. has suggested in a recent publication that the use of a dipeptidylpeptidase inhibitor in the setting of RA is a precious contribution in a determination of the role of RASFs in disease progression. The recent guidelines for the treatment and management of diabetes from the American Diabetes Asoociation, American Association of Clinical Endocrinologists and the National Institute for Health and Clinical Excellenge include DPP-4 inhibitors, a new therapeutic option. However, the available data on the inhibition of dipeptidyl peptidase in RA suggest that we should be careful in terms of the use of DPP-4 inhibitors in the treatment of diabetic patients with RA.