Background Diabetes mellitus (DM) quite commonly affects the musculoskeletal (MSK) system, resulting in significant morbidity. These manifestations may go unrecognized or simply be overlooked in daily clinical practice. In addition, factors affecting these diverse MSK complications are not yet completely understood (1).
Objectives To study the effect of DM on the MSK system, to find out the prevalence of MSK disorders in Egyptian diabetics and to study its relation with glyceamic control, duration of the disease, hyperlipideamia and type of diabetes.
Methods 100 patient of type 1 DM (T1DM), 100 patient of type 2 DM (T2DM) and 100 normal controls matched for age and sex were examined for different types of MSK disorders. Fasting and postprandial (PP) blood glucose, Glycosylated hemoglobin (HbA1C) and lipid profile (Cholesterol (Chol.), High density lipoprotein (HDL), Low density lipoprotein (LDL) and Triglycerides (TG) were done to patients and controls (2). Plain X ray dorsolumbar region and ankle joint and nerve conduction study of the median nerve were done to some selected cases.
Results The following MSK manifestations were found in T1DM & T2DM and their prevalence respectively: carpal tunnel syndrome (14% - 5%), sclerodactyly (9% -3%), Charcot joint (2% - 4%), limited joint mobility (2% - 6%), stenosing tenosynovitis (1% - 5%), shoulder capsulitis (1% - 10%), diffuse idiopathic skeletal hyperostosis (0% - 3%) and Dupuytren's contracture (0% -1%). MSK manifestations were found to be more prevalent in patients with: longer disease duration in both T1&T2DM (P<0.001); Patients with poor glyceamic control (HbA1C) in both T1DM P<0.001) & T2DM (P<0.004) Patients with higher Chol. level in both T1DM & T2DM (P<0.001). Patients with higher TG level in both T1DM (P<0.002) & T2DM (P<0.001) and patients with elevated low density lipoprotein (LDL) in both T1DM & T2DM (P<0.001).In addition, using multivariate stepwise regression analysis MSK manifestations of both T1DM & T2DM showed strong relation with glyceamic control (P=0.000, OR =2.229), duration of the disease (P=0.000, OR =1.237) and elevated LDL levels (P=0.006, OR =1.018).
Conclusions The result of the present study raises the concern about the importance of glyceamic control. In addition to the new finding that elevated levels of LDL were significantly related to MSK manifestations in both T1DM & T2DM. Further studies are warranted to clarify the potential contribution of this finding to the development of MSK manifestations in diabetic patients
Bhowmik M and Upadhyaya S. Rheumatic manifestations in diabetes mellitus patients. Apollo Med 2013, 10: 126-133
Attar SM. Musculoskeletal manifestations in diabetic patients at a tertiary center. Libyan J Med 2012, 7: 19162.
Acknowledgements We would like to thank the staff of Departments of rheumatology and Rehabilitation and Internal Medicine for their sincere cooperation and help. We are also grateful to all the patients participated in this study.
Disclosure of Interest None declared