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This mechanism is implicated in diseases such as rheumatoid arthritis (RA), where oxidative modifications of proteins in the synovial fluid contribute to the autoimmune response [127, 128]

7 Initiating and monitoring If adding a DPP-4 inhibitor to sulfonylurea, meglitinide or insulin therapy, consider whether a dose reduction of the sulfonylurea/meglitinide/insulin is needed to reduce hypoglycaemia risk

Observations: Researchers should monitor for transient facial flushing, mild water retention (edema), or tingling in the extremities (carpal tunnel-like symptoms)

Scar mobility and skin behaviour are usually evaluated first, because a fixed scar with overlying mobile tissue frequently explains a localised shelf even in patients with good muscle tone