Rheumatologic manifestations of diabetes mellitus

doi:10.1016/S0002-9343(03)00140-2

The American Journal of Medicine

Volume 114, Issue 9, 15 June 2003, Pages 753-757

https://doi.org/10.1016/S0002-9343(03)00140-2 Get rights and content

Abstract

Diabetes mellitus has been linked to disorders of bones and joints, including neuroarthropathy, limited joint mobility, and hyperostosis. Some of the relations have known pathogenic mechanisms, but most are based on epidemiologic findings. This article reviews the associations between diabetes mellitus and its putative rheumatologic manifestations, and proposes a classification composed of four categories: consequences of diabetic complications, consequences of metabolic derangements inherent to diabetes, syndromes that may share etiologic mechanisms with microvascular disease, and probable associations. This approach may facilitate a clearer understanding of the musculoskeletal conditions that are prevalent in patients with diabetes mellitus.

Section snippets

Diabetic muscular infarction

This rare condition is usually seen in patients with type 1 diabetes mellitus, particularly in those with long-standing, poorly controlled disease (7). It presents as a tender, nontraumatic thigh mass that expands during a period of days to weeks. A biopsy is necessary to distinguish this condition from hemorrhage, phlebitis, pyomyositis, and localized myositis (8). Diabetic muscular infarction is a complication of advanced atherosclerosis. Although it has a good prognosis, patients have an

Diffuse idiopathic skeletal hyperostosis

Type 2 diabetes mellitus is associated with hyperostotic changes that may present as hyperostotic spondylosis, hyperostosis frontalis interna, osteitis condensans ilii, or calcification of ligaments and tendons (5). Hyperostosis is many times more common in patients with diabetes (13% to 49%) than in the general population (1.6% to 13%); conversely, diabetes is common in patients with hyperostosis (Table 2).

Diffuse idiopathic skeletal hyperostosis (DISH) is caused by excessive new bone growth

Adhesive capsulitis of the shoulder

The association between diabetes and adhesive capsulitis of the shoulder is well established 37, 38, 39. Between 11% and 19% of patients with diabetes are affected, as compared with 2% to 3% of age-matched controls. Bilateral involvement is more frequent in patients with diabetes than in nondiabetic subjects (33% to 42% vs. 5% to 20%) (3).

Patients with adhesive capsulitis may complain of chronic pain or stiffness. The loss of range of motion causes impaired function, including limited reaching

Carpal tunnel syndrome

Although the frequency of carpal tunnel syndrome has been reported to be as high as 25% in diabetic patients, and diabetes is considered to be a cause of this syndrome (54), no controlled study has demonstrated a higher prevalence in patients with diabetes than in age- and weight-matched controls (47).

Gout

An association with obesity, type 2 diabetes, hyperinsulinism, hyperuricemia, and dyslipidemia is common in clinical practice. The primary alteration is probably obesity, which causes insulin

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Cited by (67)

Hyperostosis fronto-parietalis – radiology mimic of metastasis: A case report
2021, Radiology Case Reports
Hyperostosis frontalis interna (HFI) is a benign entity manifested by bony overgrowth in the frontal endocranial surface. It is most commonly reported incidentally among postmenopausal elderly women. Tracer uptake appearances of HFI can vary on planar bone scans, enabling it to be easily confounded with bone metastases. We report a case of HFI in a 69-year-old postmenopausal female with treated left breast cancer detected on bone scintigraphy, with subsequent confirmation by computed tomography. Our case highlights the importance of having awareness of HFI and its key pattern findings to avoid mistaking it for pathology, and to recognise the use of computed tomography and hybrid fusion imaging techniques as reliable diagnostic tools for HFI.
Limited joint mobility of the hand correlates incident hospitalisation with infection in patients with type 2 diabetes
2020, Diabetes Research and Clinical Practice
Limited joint mobility (LJM) of the hand is one of the important complications of diabetes. Diabetes is a risk factor for hospitalisation with infection. This study investigated the relationship between LJM of the hand and the incidence of hospitalisation with infection in type 2 diabetic patients.
LJM of hand was defined as the ‘prayer sign’ or ‘table test’. The association between LJM of the hand and incident hospitalisations was evaluated using Cox regression analysis. The number of incident hospitalisations was small over the course of the study, which we compensated for by calculating propensity scores using age, body mass index, sex, duration of diabetes, creatinine, smoking status, haemoglobin A1c and dyslipidaemia.
In this retrospective cohort study of 502 patients with type 2 diabetes, 102 patients had LJM of the hand. These patients were, on average, older and had worse renal function and glycaemic control, and a higher proportion of microangiopathy significantly. During the study period, 56 patients were hospitalised with infection. A Cox regression analysis showed that LJM of the hand was associated with an increased probability of incident hospitalisation with infection after adjustment for covariates (HR = 1.65 [95% CI 1.60–1.70], p < 0.001).
Our results reveal that LJM of the hand is associated with incident of hospitalisation with infection. A diagnosis of LJM of the hand might, therefore, be a useful indicator for assessing the risk of hospitalisation with infection in type 2 diabetic patients.
Cheiroarthropathy: A common disorder in patients in the T1D exchange
2019, Endocrine Practice
Objective: Diabetic cheiroarthropathy is a long-term complication of diabetes that causes significant morbidity and can impair functional abilities. It has not been well studied in individuals with type 1 diabetes (T1D). The T1D Exchange registry provided an opportunity to assess the frequency of cheiroarthropathy and related characteristics.
Methods: An internet-based survey was sent to 6,199 registry participants ≥18 years old, with 1,911 (31%) responding (62% female, 90% non-Hispanic White, mean age 40 years, median diabetes duration 20 years, mean glycated hemoglobin [HbA1c] 7.7% [61 mmol/mol]).
Results: A total of 586 (31%) adults reported a diagnosis of ≥1 upper extremity disorder: 293 (15%) reported frozen shoulder, 293 (15%) trigger finger, 261 (14%) carpal tunnel, and 92 (5%) Dupuytren contracture, with 281 (15%) reporting ≥2 disorders. Those with upper extremity joint disorders were more likely older (P<.001) and had longer duration of diabetes (P<.001) than those without. HbA1c levels at the time of survey completion were 7.6% in participants with cheiroarthropathy versus 7.8% (62 mmol/mol) in participants without cheiroarthropathy.
Conclusion: Cheiroarthropathy is common in adults with T1D. Additional research is needed to understand the pathogenesis and risk factors for this disorder. Standards of care for early recognition and treatment of diabetic cheiroarthropathy are also needed, particularly for adults with long-term diabetes. Improved awareness of cheiroarthropathy signs and symptoms of is needed so that patients can be identified and seek treatment before the condition causes disability.
Abbreviations: BMI = body mass index; CGM = continuous glucose monitor; DCCT/EDIC = Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications; HbA1C = glycated hemoglobin; T1D = type 1 diabetes; T2D = type 2 diabetes
Relationship between limited joint mobility of hand and carotid atherosclerosis in patients with type 2 diabetes
2017, Diabetes Research and Clinical Practice
Limited joint mobility (LJM) of hand, which is one of a complication of diabetic hand, has a close association with diabetic microangiopathy. However, it remains to be elucidated about the relationships between LJM of hand and subclinical atherosclerosis in patients with type 2 diabetes. Therefore, we conducted a cross-sectional study to evaluate the relationships between LJM of hand and carotid intima-media thickness (IMT) and plaque score in patients with type 2 diabetes.
We evaluated the relationships between LJM of hand, and carotid IMT and plaque score, evaluated by carotid ultrasound examination, in 341 consecutive patients with type 2 diabetes. LJM of hand was diagnosed using a ‘prayer sign’ or ‘table test’.
LJM of hand was present in 72 patients. Carotid IMT and plaque score were higher in patients with LJM of hand than those in patients without (1.45 ± 0.66 vs. 1.14 ± 0.68 mm, P = 0.013 and 8.0 ± 5.3 vs. 5.4 ± 4.8 mm, P < 0.001). Multivariate linear regression analysis revealed that LJM of hand was positively correlated with plaque score (β = 0.423, P = 0.043) after adjusted for age, sex, durations of diabetes, body mass index, hemoglobin A1c, creatinine, uric acid, smoking, hypertension and dyslipidemia.
Our results demonstrate a relation between LJM of hand and subclinical atherosclerosis, especially plaque score, in patients with type 2 diabetes. Diagnosis of diabetic hand is simple and non-invasive, and thus is a useful method for assessment of subclinical atherosclerosis in patients with type 2 diabetes.
Influence of diabetes on response to ultrasound guided hydrodistension treatment of adhesive capsulitis: a retrospective study
2022, BMC Endocrine Disorders
Musculoskeletal system disorders and kinesiophobia in type 2 diabetes: A case–control study
2021, Australian Journal of Rehabilitation Counselling

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ReviewRheumatologic manifestations of diabetes mellitus

Abstract

Section snippets

Diabetic muscular infarction

Diffuse idiopathic skeletal hyperostosis

Adhesive capsulitis of the shoulder

Carpal tunnel syndrome

Gout

Clin Rheum Dis

Endocrinol Metab Clin North Am

Am J Med

Magn Reson Imaging

Semin Arthritis Rheum

J Diabetes Complications

J Diabetes Complications

Diabetes Res Clin Pract

J Diabetes Complications

Am J Med

Semin Arthritis Rheum

J Hand Surg (Am)

Am J Med

Metabolism

Semin Arthritis Rheum

Endocrine disorders

Curr Opin Rheumatol

Skeletal and rheumatologic complications of diabetes

Adv Endocrinol Metab

Endocrine disorders

Curr Opin Rheumatol

Musculoskeletal complications of diabetes mellitus

Clin Diabetes

Diabetic muscular infarction

Semin Arthritis Rheum

Du cerveau ou de la moelle epiniere

Arch Physiol Nom Pathol

Neuro-arthropathy in diabetes mellitus

Medicine

The neuropathic joint

Clin Exp Rheumatol

Endocrine and hemoglobin-related arthropathies and storage diseases. Diabetes mellitus

Pathogenesis of the neuropathic jointneurotraumatic vs. neurovascular

Radiolo

Hyperostosis of the spine in an adult populationits relationship to hyperglycemia and obesity

Ann Rheum Dis

Bones and Joints in Diabetes Mellitus

Vertebral hyperostosis and diabetes mellitusa case-control study

Ann Rheum Dis

A metabolic syndrome in diffuse idiopathic skeletal hyperostosis. A controlled study

J Rheumatol

Risk factors for diffuse idiopathic skeletal hyperostosisa case-control study

Rheumatology

Insulin and new bone formation in diffuse idiopathic skeletal hyperostosis

Clin Rheumatol

Review
Rheumatologic manifestations of diabetes mellitus