Guest guest Posted March 17, 2007 Report Share Posted March 17, 2007 In the last three weeks I have been diagnosed with complications which I believe are directly related to PSC. I was diagnosed 3 weeks ago with osteopenia and finally gave in to taking the fosamax after I was sure it was ok. This past week, I have been diagnosed with diabetes and most recently elevated creatinine in my blood indicating poor kidney function Although I refuse to let this disease define me; I can't help but believe this is related to 13 years of PSC. I am concerned about the relationship of Diabetes to PSC and its potential harm or detriment to future treatments, i.e. transplants, ercps. I would appreciate any thoughts from those who may have similar issues. Thanks Phil 50 Psc/uc: 93 ________________________________________________________________________________\ ____ 8:00? 8:25? 8:40? Find a flick in no time with the Yahoo! Search movie showtime shortcut. http://tools.search.yahoo.com/shortcuts/#news Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2007 Report Share Posted March 17, 2007 > > In the last three weeks I have been diagnosed with > complications which I believe are directly related to > PSC... This past week, I have been diagnosed with > diabetes and most recently elevated creatinine in my > blood indicating poor kidney function Although I > refuse to let this disease define me; I can't help but > believe this is related to 13 years of PSC. I am > concerned about the relationship of Diabetes to PSC > and its potential harm or detriment to future > treatments, i.e. transplants, ercps. Hello to and Barb and others who do research for us so well and seemingly efficiently (I'm sure faster and better than I do!)... I have had the same questions as Phil. Is there a higher prevalence of diabetes among PSC'ers? If so, any ideas why (other than potential higher prednisone use due to history of UC... or quiescent chronic pancreatitis... or....???). If there is higher incidence, I wonder if there is a protective benefit by careful diet, with low concentrated sweets (which I think many do by watching their fat intake and pie, cake, candy, ice cream, etc are all high sugar and high fat!). I'd be curious if there is any literature on incidence of diabetes with PSC and/or more general liver disease. Thanks for your time. Joanne (, Ca, mom of , 16, PSC/UC 2-06; JRA 2-98) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2007 Report Share Posted March 18, 2007 Hi Joanne; I've read that there seems to be a higher incidence of autoimmune diseases in PSCers, and this may be in part be a genetic predisposition: Am J Gastroenterol. 2000 Nov;95(11):3195-9. Increased frequency of autoimmune diseases in patients with primary sclerosing cholangitis. Saarinen S, Olerup O, Broome U Department of Gastroenterology and Hepatology, Karolinska Institute at Huddinge University Hospital, Stockholm, Sweden. OBJECTIVES: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown origin that mostly affects male patients with inflammatory bowel disease (IBD). The immune system is believed to be involved in the etiology/pathogenesis as these patients present with several immunological disturbances. Susceptibility to develop primary sclerosing cholangitis is partly determined by genes in the HLA complex. The aim of this study was to compare the prevalence of autoimmune disorders in IBD patients with and without PSC and to correlate the presence of autoimmune disorders in PSC to outcome and HLA association. METHODS: One hundred nineteen PSC patients were included in the study. Each PSC patient with IBD was matched to a IBD patient without PSC. The presence of autoimmune disorders was carefully evaluated in each group. Moreover, comparisons between PSC patients with and without autoimmune disorders were performed. RESULTS: Twenty-five percent of the PSC patients had at least one autoimmune disorder outside the liver and colon compared to 9% in the IBD group without PSC (p < 0.005). Nine of the PSC patients had two or more autoimmune diseases compared to only one patient in the IBD group (p < 0.02). The PSC patients with and without associated autoimmune disease did not differ in clinical presentation, outcome of PSC or HLA alleles. A significant overrepresentation of DRB1*03 was still present after excluding PSC patients with concomitant autoimmune diseases outside the liver and colon compared to a healthy Swedish control group. CONCLUSIONS: Autoimmune disorders are more frequent among PSC patients compared to IBD patients without liver disease. Associated autoimmune diseases in PSC patients does not influence the outcome or clinical presentation of PSC. PMID: 11095341. I can't access the full manuscript of this paper right now to find out which autoimmune diseases they considered. But I'll try to get the details for you tomorrow. Potincasa lists the diseases most commonly associated with PSC: Table 1 Diseases most commonly associated with PSC Celiac disease Rheumatoid arthritis Thyroiditis Sjogren's syndrome Lupus erythematosus Lupic nephritis Chronic pancreatitis Retroperitoneal fibrosis Systemic sclerosis Peyronie's disease Autoimmune hemolytic anemia Immune thrombocytopenic purpura Membranous nephropathy Histiocytosis X Cystic fibrosis Angioblastic lymphadenopathy Intra-abdominal adenopathy Vasculitis Pseudotumor of the orbit Gallbladder disease (Portincasa P, Vacca M, Moschetta A, Petruzzelli M, Palasciano G, van Erpecum KJ, van Berge-Henegouwen GP. Primary sclerosing cholangitis: updates in diagnosis and therapy. World J Gastroenterol. 2005 Jan 7;11 (1):7-16. PMID: 15609388) Suprisingly diabetes is not on this list, suggesting that it may be relatively rare? The following paper suggests that the " unusual " combination of PSC, UC and diabetes might be associated with specific genes/alleles in the human leukocyte antigen (HLA) complex: J Intern Med. 1993 Mar;233(3):281-6. HLA-DR3, DQ2 homozygosity in two patients with insulin-dependent diabetes mellitus superimposed with ulcerative colitis and primary sclerosing cholangitis. Ivarsson SA, sson S, Kockum I, Lernmark A, Lindgren S, Nilsson KO, Sundkvist G, Wassmuth R Department of Paediatrics, University of Lund, Malmo General Hospital, Sweden. Two unrelated young males with the unusual simultaneous presence of insulin-dependent diabetes mellitus, ulcerative colitis and primary sclerosing cholangitis are reported. Both patients manifested homozygosity for the DR3-DQw2 (DQB*0201) HLA genotypes. We believe that homozygosity for this genotype may predispose for this type of multi-organ autoimmune disease. PMID: 8450297. Best regards, Dave (father of (21); PSC 07/03; UC 08/03) > I'd be curious if there is any literature on incidence of diabetes > with PSC and/or more general liver disease. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2007 Report Share Posted March 18, 2007 This is interesting. My mother has hyperthyroidism, my sister has UC (no PSC) and I have PSC (no IBD). Chaim Boermeester, Israel From: [mailto: ] On Behalf Of Sent: Sunday, March 18, 2007 9:09 AM To: Subject: Re: psc complications Hi Joanne; I've read that there seems to be a higher incidence of autoimmune diseases in PSCers, and this may be in part be a genetic predisposition: Am J Gastroenterol. 2000 Nov;95(11):3195-9. Increased frequency of autoimmune diseases in patients with primary sclerosing cholangitis. Saarinen S, Olerup O, Broome U Department of Gastroenterology and Hepatology, Karolinska Institute at Huddinge University Hospital, Stockholm, Sweden. OBJECTIVES: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown origin that mostly affects male patients with inflammatory bowel disease (IBD). The immune system is believed to be involved in the etiology/pathogenesis as these patients present with several immunological disturbances. Susceptibility to develop primary sclerosing cholangitis is partly determined by genes in the HLA complex. The aim of this study was to compare the prevalence of autoimmune disorders in IBD patients with and without PSC and to correlate the presence of autoimmune disorders in PSC to outcome and HLA association. METHODS: One hundred nineteen PSC patients were included in the study. Each PSC patient with IBD was matched to a IBD patient without PSC. The presence of autoimmune disorders was carefully evaluated in each group. Moreover, comparisons between PSC patients with and without autoimmune disorders were performed. RESULTS: Twenty-five percent of the PSC patients had at least one autoimmune disorder outside the liver and colon compared to 9% in the IBD group without PSC (p < 0.005). Nine of the PSC patients had two or more autoimmune diseases compared to only one patient in the IBD group (p < 0.02). The PSC patients with and without associated autoimmune disease did not differ in clinical presentation, outcome of PSC or HLA alleles. A significant overrepresentation of DRB1*03 was still present after excluding PSC patients with concomitant autoimmune diseases outside the liver and colon compared to a healthy Swedish control group. CONCLUSIONS: Autoimmune disorders are more frequent among PSC patients compared to IBD patients without liver disease. Associated autoimmune diseases in PSC patients does not influence the outcome or clinical presentation of PSC. PMID: 11095341. I can't access the full manuscript of this paper right now to find out which autoimmune diseases they considered. But I'll try to get the details for you tomorrow. Potincasa lists the diseases most commonly associated with PSC: Table 1 Diseases most commonly associated with PSC Celiac disease Rheumatoid arthritis Thyroiditis Sjogren's syndrome Lupus erythematosus Lupic nephritis Chronic pancreatitis Retroperitoneal fibrosis Systemic sclerosis Peyronie's disease Autoimmune hemolytic anemia Immune thrombocytopenic purpura Membranous nephropathy Histiocytosis X Cystic fibrosis Angioblastic lymphadenopathy Intra-abdominal adenopathy Vasculitis Pseudotumor of the orbit Gallbladder disease (Portincasa P, Vacca M, Moschetta A, Petruzzelli M, Palasciano G, van Erpecum KJ, van Berge-Henegouwen GP. Primary sclerosing cholangitis: updates in diagnosis and therapy. World J Gastroenterol. 2005 Jan 7;11 (1):7-16. PMID: 15609388) Suprisingly diabetes is not on this list, suggesting that it may be relatively rare? The following paper suggests that the " unusual " combination of PSC, UC and diabetes might be associated with specific genes/alleles in the human leukocyte antigen (HLA) complex: J Intern Med. 1993 Mar;233(3):281-6. HLA-DR3, DQ2 homozygosity in two patients with insulin-dependent diabetes mellitus superimposed with ulcerative colitis and primary sclerosing cholangitis. Ivarsson SA, sson S, Kockum I, Lernmark A, Lindgren S, Nilsson KO, Sundkvist G, Wassmuth R Department of Paediatrics, University of Lund, Malmo General Hospital, Sweden. Two unrelated young males with the unusual simultaneous presence of insulin-dependent diabetes mellitus, ulcerative colitis and primary sclerosing cholangitis are reported. Both patients manifested homozygosity for the DR3-DQw2 (DQB*0201) HLA genotypes. We believe that homozygosity for this genotype may predispose for this type of multi-organ autoimmune disease. PMID: 8450297. Best regards, Dave (father of (21); PSC 07/03; UC 08/03) > I'd be curious if there is any literature on incidence of diabetes > with PSC and/or more general liver disease. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2007 Report Share Posted March 18, 2007 > I can't access the full manuscript of this paper right now to find > out which autoimmune diseases they considered. But I'll try to get > the details for you tomorrow. Hi Joanne; I've uploaded the Saarinen paper to the files/research folder. Looking at the details presented in this paper it appears that PSC with diabetes is not that rare [at least in Scandinavia]! My apologies for jumping to a false conclusion in my earlier post! Best regards Dave (father of (21); PSC 07/03; UC 08/03) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2007 Report Share Posted March 18, 2007 Dave - Thanks for both of your responses. I copied the article you sent. I have seen other lists of autoimmune diseases which do include diabetes. We actually saw the elevated LFT's on blood work for done 7 years prior to his PSC diagnosis. He was having acute abdominal pain, with symptoms so similar to GERD (GI reflux). On work-up, all that showed was non-functional gallbladder and elevated LFT's. Prilosec and diet changes helped somewhat for all those years. The original lab work was done for his medications for Juvenile Rheumatoid Arthritis (which I felt so pleased that it was the pausi-articular arthritis which kids typically grew out of!). His knees still bother him and unfortunately, when his PSC/UC are bad, his entire spinal column hurts him. has a first cousin with juvenile diabetes (on my dad's side). His grandmother (my mom) was diagnosed last year with ulcerative colitis, age 74. Nearly all of my aunts, uncles and grandparents on both sides of family have diabetes! Our family is a mix of paternal Jewish Belarus and English/Irish/French! One other interesting thing - I recently read (but heaven knows where) that someone believes that nearly 100% of PSC patients will eventually demonstrate symptoms of UC or Crohns. Wish I could remember where I read that. As always, thank you SO Much for your research and time and thoughts. Joanne (, Ca., mom of , 16, UC/PSC 2-06; JRA 2-98) > > Table 1 Diseases most commonly associated with PSC > > Celiac disease > Rheumatoid arthritis > Thyroiditis > Sjogren's syndrome > Lupus erythematosus > Lupic nephritis > Chronic pancreatitis > Retroperitoneal fibrosis > Systemic sclerosis > Peyronie's disease > Autoimmune hemolytic anemia > Immune thrombocytopenic purpura > Membranous nephropathy > Histiocytosis X > Cystic fibrosis > Angioblastic lymphadenopathy > Intra-abdominal adenopathy > Vasculitis > Pseudotumor of the orbit > Gallbladder disease > > Suprisingly diabetes is not on this list, suggesting that it may be > relatively rare? The following paper suggests that the " unusual " > combination of PSC, UC and diabetes might be associated with > specific genes/alleles in the human leukocyte antigen (HLA) complex: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2007 Report Share Posted March 18, 2007 -----Original Message----- has a first cousin with juvenile diabetes (on my dad's side). Nearly all of my aunts, uncles and grandparents on both sides of family have diabetes! Joanne, I found – literally - dozens of studies that say diabetes can lead to liver disease. Also found one article that said, in some cases they actually couldn’t figure out which came first – diabetes or liver disease. Barb in Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2007 Report Share Posted March 18, 2007 > Joanne, > I found - literally - dozens of studies that say diabetes can lead to > liver disease. Also found one article that said, in some cases they > actually couldn't figure out which came first - diabetes or liver > disease. Pretty fascinating - the functions of liver and pancreas are so complex... it just makes you wonder if we could figure out the relationships, where would that lead in looking for treatments and cure. Joanne (, Ca) Quote Link to comment Share on other sites More sharing options...
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