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Musculoskeletal and Joint Manifestations in Type II Diabetes Mellitus Kamath Surendra Umesh* and Ranganatha Y.P

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Musculoskeletal and Joint Manifestations in Type II Diabetes Mellitus Kamath Surendra Umesh* and Ranganatha Y.P American Journal of Advanced Drug Delivery www.ajadd.co.uk Original Article Musculoskeletal and Joint Manifestations in Type II Diabetes Mellitus Kamath Surendra Umesh* and Ranganatha Y.P. Kasturba Medical College Hospital, Attavar, Mangalore, Manipal University, Manipal, Karnataka, India Date of Receipt- 25/12/2014 ABSTRACT Date of Revision- 05/01/2015 Date of Acceptance- 16/01/2015 Objective: Incidence of diabetes and life expectancy in these patients has increased resulting in increased prevalence of musculoskeletal problems in diabetic patients. Musculoskeletal complications related to diabetes are common and can lead to severe morbidity. These complications may be due to metabolic or microvascular causes. Increased prevalence of these connective tissue disorders in the recent times has affected the quality of life for these patients. This study was carried out with aim to find the prevalence and types of rheumatological manifestations in patients having type 2 Diabetes mellitus. Patients and Methods: A total of 150 patients with Type 2 diabetes mellitus were chosen randomly in this cross sectional study with inclusion criteria of disease duration for minimum of 1 year. Those patients who were too ill, willing to participate and with inflammatory arthritis were excluded. Data was analysed using SPSS software version 17. Results: A total of 150 subjects were assessed for various Address for musculoskeletal manifestations. A total of 46 subjects amounting to Correspondence about 30.66% had the manifestation. The age ranged from 20 to 76 years with a mean age of 51.8 years. The duration of diabetes was Kasturba Medical of less than 5 years in 8 patients and was of more than 5 years in 38 College Hospital, patients Attavar, Mangalore, Conclusions: From the above observation it is clear that about 29% Manipal University, suffer from rheumatological manifestations with most common seen Manipal, Karnataka, in knee and shoulder joint. India. E-mail: skamath3@ Keywords: Musculoskeletal complications, Diabetes mellitus, hotmail.com Osteoarthrosis, Frozen shoulder. American Journal of Advanced Drug Delivery www.ajadd.co.uk Kamath et al ___________________________________________________ ISSN 2321-547X INTRODUCTION Diabetes mellitus is a metabolic This study was conducted with aim condition characterized by persistent to find the proportion and type of hyperglycemia with resultant morbidity and musculoskeletal and joint manifestations in mortality related primarily to its associated patients having Type 2 Diabetes mellitus. microvascular and macrovascular complica- tions1. Type 2 Diabetes mellitus is a highly PATIENTS AND METHODS prevalent disorder worldwide. India is popularly known as a “diabetes capital of This study was done at teaching the world”. Diabetes can affect the hospitals attached to Kasturba Medical individuals by the disease per se as well as College Mangalore, Karnataka .South India, the complications that occur over the period after getting clearance from the Institutional of years. Important and common Ethical Committee. complications include neuropathy, A total of 150 patients with Type 2 nephropathy and retinopathy. diabetes mellitus were selected randomly Musculoskeletal complications from inpatients and outpatients attending the related to diabetes are common and can lead departments of Medicine and Orthopaedics. to severe morbidity. Inclusion criteria considered all the patients Consequences following diabetic with Type 2 diabetes mellitus who attended complication are, muscle infarction, hospital Outpatient and in patients. neuropathic arthropathy, Charcot joint2. Also those patients with the history Metabolic derangements, can lead to of diabetes for minimum of 1 year were diffuse idiopathic skeletal hyperostosis included. (DISH) and osteopenia. DISH is not only Exclusion criteria included the associated with Type 2 diabetes mellitus but patients who were too ill to be interviewed also seen in patients with obesity, and examined, those unwilling to participate hyperuricaemia and dyslipidaemia. and patients with inflammatory arthritis. A Syndromes due to microvascular disease detailed history and clinical examination carpal tunnel syndrome, Duputren’s was undertaken in each patient with contracture, flexor synovitis, Adhesive emphasis on musculoskeletal examination capsulitis, limited joint mobility. Other after obtaining a written informed consent. complication like Sclerodactyly, Calcific Data was recorded in a proforma. Physical Tendinitis of Shoulder, Periarthritis of examination was focused on hand and Shoulder, Reflex SympatheticDystrophy2,3 . shoulder abnormalities. longer duration of diabetes, especially with The presence of carpal tunnel poor glycemic control, increase the risk of syndrome was defined as pain and developing many of the mentioned paraesthesia of the first, second, and third complications. Connective tissue disorders, fingers, plus a positive Tinel’s or Phalen’s neuropathy, vasculopathy and combinations sign. Dupuytren’s disease was diagnosed in may result in musculoskeletal complications patients with palpable thickening of the in diabetic patients. The development of palmar fascia, with flexor deformity of the musculoskeletal problems depends on age second, third, fourth, or fifth fingers. Flexor and duration of diabetes. Early recognition tenosynovitis was diagnosed by feeling a and treatment will increase the quality of life nodule with locking phenomenon during in these patients. extension or flexion of any fingers. Adhesive capsulitis of the shoulder was AJADD[3][1][2015] 059-063 Kamath et al ___________________________________________________ ISSN 2321-547X diagnosed t when unilateral shoulder present common findings were frozen shoulder, for over 3 months and the range of external osteoarthritis and dupuytren’s contracture; rotation and active and passive shoulder these were seen in diabetic females. movements in all planes was less than 50% In this study out of 150 subjects, of normal. Past history of any surgery for 43(28.66%) were having manifestations any of these disorders was also considered. compared to Ashish et al around 42.58%. Data collected was analysed using The most common manifestation in SPSS software version 17. this study was osteoarthritis of knee (50%), this is same as study done by ashish et al RESULTS .the finding was confirmed by asking the history and duration of pain in the joint. A total of 150 subjects with diabetes Second most common finding is frozen of >1yr duration were examined for various shoulder which is commonly seen in musculoskeletal manifestation. A total of 43 diabetic woman. These cause more painful subjects amounting to about 28.66% had the debilitating restriction of joint movement. manifestation (Figure 1). The age ranged Studies done earlier shown similar results. from 20 to 76 years with a mean age of 51.8 Duration of diabetes more commonly years. strongly associated with microangiopathic In this study more number of women complication, most of the symptomatic are examined compared to men with more subjects are of >5 yrs. duration these positive results in women.Total numbers of findings are also seen in studies done by women were 85 and men were 65 in this Ashish et al and Cagliero et al4,5. In this study. Duration of diabetics for less than 5 study numbers more women were affected years was in 5 patients and 38 patients had comparing with the men. The other diabetes duration for more than 5 years manifestation like carpal tunnel syndrome, The most common findings were Charcot joints were not seen during osteoarthritis and frozen shoulder, examination of subjects. interestingly these are seen diabetics of more Pathogenesis of adhesive capsulitis, than 5 year duration and some subjects had dupuytren’s contracture and flexor multiple manifestation causing overlap of tenosynovitis not understood, glucose numbers. More than one musculoskeletal induced collagen modifications might be an manifestation manifestation was seen in 12 important component of this syndrome. patients. Prevalence of musculoskeletal Adhesive capsulitis of shoulder is thought to disorders in the study population be due to fibrosis and inflammation. includedFrozen shoulder in 18, Dupuytren’s Diabetes can induce fibrosis by contracture in 6, Osteoarthritis 22 and altering proliferative characteristics of Trigger finger 0(Figure 2). several cell types and increased expression The duration of diabetes also had a of cytokines6-9 key role in various manifestations and its severity as 38 patients out of 43 had diabetes CONCLUSION lasting for more than 5 years. From the above observation it is DISCUSSION clear that about 29% of the type 2 diabetics suffer from rheumatological manifestations. Musculoskeletal complication The most common manifestations are seen involving hand and shoulder was common in in knee and shoulder joint. diabetic patients. In this study the most AJADD[3][1][2015] 059-063 Kamath et al ___________________________________________________ ISSN 2321-547X From this study it could be 4. Mathew AJ, Nair JB and Pillai SS. concluded that thorough examination of Rheumatic- usculoskel et al musculoskeletal system should be made a manifestations in type 2 Diabetes part of physical examination in diabetics. So mellitus patients in south India. life style modification and exercises to International Journal of Rheumatic various joints should be part of diabetic Diseases 2011;14: 55–60. management. 5. Cagliero E, Apruzzese W, Perlmutter GS, Nathan DM, .Musculoskeletal
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