A 35-year-old man with type 1 diabetes mellitus and chronic renal failure requiring hemodialysis was diagnosed with diabetes mellitus at age 14 and began dialysis therapy when 34 years old. HbA₁c was 8.5%, and he was hospitalized to control plasma glucose. On admission, he reported pain and swelling of the hand, shoulder, and knee joints. Serum C-reactive protein was 15.7mg/dl and erythrocyte sedimentation 86mm/h, suggesting severe inflammation. He was diagnosed with rheumatoid arthritis. Symptoms resolved immediately after steroid therapy was started.
Several cases of type 1 diabetes with other autoimmune diseases have been reported. Chronic renal failure is known to be associated with severe immune suppression. So it is considered that chronic renal failure and collagen diseases are hard to complicate with. Membrane use during hemodialysis reportedly activates leukocytes and uremia stimulates the production of circulating inflammatory cytokines. Further studies are therefore required to clarify the mechanism of rheumatoid arthritis occurring with type 1 diabetes mellitus and end-stage renal disease.