Diabetics are more prone to bone-related conditions

DUBAI - Diabetic patients suffer disproportionately from common musculoskeletal conditions in terms of increased prevalence, severity, and morbidity, according to a doctor.

“The high glucose, high insulin milieu of diabetic tissues affects many of the key cells,” said Dr Saleh Mohammed Kagzi, Orthopaedics Surgeon, Zulekha Hospital, Dubai.

Osteoarthritis is the most common form of arthritis in adults and as such would frequently co-occur with diabetes by chance alone, he said. “Peripheral neuropathy, a common complication of diabetes, may also adversely affect joints and increase the risk of advanced, aggressive forms of osteoarthritis.”

“Diabetes may also affect the outcomes of therapy in osteoarthritis. It was noted in a study that there is a propensity for diabetic patients to have more severe pain and radiographic changes both preoperatively and postoperatively, an increased risk of deep tissue infection as well as an increased revision rate compared with non-diabetic,” he added.

Although diabetes is not recognised as an independent risk factor for the development of rheumatoid arthritis (RA), many patients suffer from both conditions. “Carpal Tunnel Syndrome (CTS) is a common compression neuropathy of the median nerve associated with many conditions including diabetes.”

Diabetes may induce structural alterations of tendon, increase obesity, and produce metabolic abnormalities that result in proliferation or fibrosis of the connective tissues surrounding the nerve.

Metabolic conditions including diabetes are thought to impair bone homeostasis. Type 1 diabetes has been associated with abnormal bone formation or bone turnover, or both possibly leading to decreased bone mineral density (BMD) and increased marrow adiposity.

“Gout is an acute and chronic arthritis caused by monosodium urate (MSU) crystals. Hyperuricemia is a necessary condition for gout and is part of the constellation of lipid and non-lipid cardiovascular risk factors typically defined as the metabolic syndrome,” explained Dr Kagzi.

“Type II diabetes is also a part of this syndrome and as such, an association of gout and type II diabetes would be expected. Renal insufficiency, a common complication of diabetes, also predisposes to gout.”

In contrast, several of the musculoskeletal syndromes associated with the hydroxyapatite-like basic calcium phosphate (BCP) crystals such as calcific tendinitis are clearly associated with diabetes. Charcot arthropathy, which is also called neuropathic arthritis, is a serious complication of diabetes, he said.

“It is characterised by fracture, dislocation, and subluxation of the affected joint in the presence of a significant sensory deficit. Charcot arthropathy typically affects the foot in diabetic patients with peripheral neuropathy. Late stages are often complicated by refractory skin ulcers and may culminate in amputation.”

Tendinopathies occur frequently in patients with diabetes. Painful tendinopathies, including shoulder tendinitis, limited hand mobility (cheiropathy), tendon ruptures, and adhesive capsulitis affect 30-60 per cent of diabetic patients, and cause considerable disability among affected patients.

Flexor tenosynovitis in the hand is also quite common in diabetic patients with a prevalence estimated at 10-20 per cent of diabetic patients. Interestingly, diabetes and its control may also affect therapy, he said. Although inter-sheath injections are typically very successful for flexor tenosynovitis in the hand, high hemoglobin A1C levels, reflecting poor diabetic control, adversely affect results from this intervention. Tendon rupture may also be associated with diabetes.—news@khaleejtimes.com