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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 3  |  Issue : 2  |  Page : 19-21

Rheumatological Manifestations in Diabetic Population from Bihar


1 Associate Professor, Department of General Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
2 Assistant Professor, Department of Endocrinology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
3 Assistant Professor, Department of General Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
4 Assistant Professor, Department of Community Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
5 Senior Resident, Department of General Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India

Date of Web Publication11-Dec-2020

Correspondence Address:
Arshad Ahmad
Associate Professor, Department of General Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna -14
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Rheumatological disorders in diabetic patients are generally neglected, but their prevalence is quite high in diabetic patients. This was an observational, prospective hospital based study conducted on 200 diabetic patients from IGIMS OPD, Department of Medicine and Department of Endocrinology. Females (60.5%) predominated the males (39.5%). Most of the patients were of type 2 Diabetes Mellitus. Mean age of the groups was 50.77 years, mean duration of Diabetes Mellitus was 76 months, mean Body Mass Index was 31.3kg/m2, and mean HBA1c of the groups was 8.07%. Osteoarthritis is the most commonly encountered Rheumatological manifestation in our study (43%) followed by frozen shoulder (30.5 %) and limited joint mobility (20.5%). Flexor tenosynovitis was present in 6.5%, Diffuse idiopathic skeletal hyperostosis (DISH) was present in 8% and Dupuytren’s Contracture was present in 9.5%. Our study shows common rheumatological manifestation in Diabetes mellitus were Osteoarthritis, Frozen shoulder and Limited joint Mobility. Our study shows duration of diabetes has important risk factors for development of rheumatological manifestations.

Keywords: Diabetics, Rheumatological, Osteoarthritis, Frozen Shoulder, Limited Joint Mobility, Flexor Tenosynovitis, DISH, Dupuytren’s Contracture.


How to cite this article:
Ahmad A, Prakash V, Kumar P, Mishra AK, Kumar S, Ansari FA, Roshan R. Rheumatological Manifestations in Diabetic Population from Bihar. J Indira Gandhi Inst Med Sci 2017;3:19-21

How to cite this URL:
Ahmad A, Prakash V, Kumar P, Mishra AK, Kumar S, Ansari FA, Roshan R. Rheumatological Manifestations in Diabetic Population from Bihar. J Indira Gandhi Inst Med Sci [serial online] 2017 [cited 2021 Dec 7];3:19-21. Available from: http://www.jigims.co.in/text.asp?2017/3/2/19/303140




  Introduction Top


Diabetes Mellitus (DM) is associated with several musculoskeletal manifestations. The rising incidence of DM and increased expectancy of diabetic patients have resulted in increased prevalence and clinical importance of musculoskeletal alterations in diabetic subjects.[1] The exact pathophysiology of most of these musculoskeletal disorders remains obscure. Connective tissue abnormality, neuropathy, vasculopathy or combination of these problem, may underlies the increased incidence of musculoskeletal disorders in DM.[2] Rheumatological disorders described in patients with diabetes can be divided into three categories[3].

  1. Disorder which represents intrinsic complications of diabetes which include


    1. Diabetic muscle infarction
    2. Neuropathic arthropathy (Charcot’s joint, Claw toe)


  2. Rheumatological disorders under this category can be further divided into two groups:


    1. Disorder related to metabolic derangements


      1. Diffuse idiopathic skeletal hyperostosis(DISH)
      2. Osteopenia
      3. Osteopororosis


    2. Disorders which share similar etiological mechanism as with microvascular disease and change of collagen


      1. Limited joint mobility (chieroarthropathy)
      2. Dupuytren’s contracture
      3. Palmar flexure tenosynovitis (Trigger finger)
      4. Adhesive capsulitis of the shoulder (Frozen shoulder)
      5. Reflex sympathetic dystrophy (algodystrophy)


  3. Other rheumatological disorders which are common in General populations having increased prevalence in Diabetic population


    1. Carpal tunnel syndrome
    2. Gout
    3. Osteoarthritis
    4. Osteolysis of forefoot
    5. Migratory osteolysis of hip and knee


Rheumatological disorders in diabetic patients are generally neglected, but their prevalence is quite high in diabetic patients[4]. Though studies are available regarding rheumatological manifestations in diabetic patients but datas from our region are scarce. Hence, we planned to study rheumatological manifestations in diabetic patients. Early and timely diagnosis can reduce rheumatological manifestations, otherwise these complications can compromise the quality of life in diabetic patients[5].

Indira Gandhi Institute of Medical Sciences (IGIMS), Patna is a pioneer tertiary care hospital of Bihar, in where patients come from different parts of Bihar. So study here can represents the entire population of Bihar.


  Aims & Objective Top


To study the prospective data on the trend of rheumatological manifestation in 200 diabetic patients from IGIMS OPD, Department of Medicine and Department of Endocrinology.


  Material and Methods Top


This study was an observational, prospective, population - based study conducted in Medicine & Endocrine OPD of IGIMS, Patna, Bihar from January 2016 to june 2016 in which patients of either sex who were Diabetic and had rheumatological manifestations were included.


  Inclusion Criteria Top


Patients of both sex who have Diabetes Mellitus.

Exclusion Criteria

1- Patients with renal osteodystrophy.

2- Rheumatoid arthritis patients

3- Patients with collagen vascular disorder

4- Patients with history of trauma- related musculoskeletal morbidities.

Each patient was subjected to detailed history and complete physical examination. Proper Laboratory test and radiological investigation were done to assess the musculoskeletal complications.

The study obtained clearance from Institutional Ethics Committee.


  Results Top


200 diabetic patients with rheumatological manifestations were analysed.
Table 1: Sex distribution

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Table 2: Type 1 and Type 2 distribution

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Table 3: Demographic profile

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Table 4: Case distribution according to rheumatological manifestations

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Table 5: Rheumatological manifestations in relation to duration of diabetes mellitus

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  Discussion Top


200 diabetic patients with rheumatological manifestations were analysed. Females (60.5%) predominated the male (39.5%). Most of the patients were of type 2 Diabetes Mellitus.

Mean age of the groups was 50.77 years, mean duration of Diabetes Mellitus was 76 months, mean Body Mass Index was 31.3kg/m2, and mean HBA1c of the groups was 8.07%. Osteoarthritis was the most commonly encountered Rheumatological manifestation in our study (43%) followed by frozen shoulder (30.5 %) and limited joint mobility (20.5%). Flexor tenosynovitis was present in 6.5%, Diffuse idiopathic skeletal hyperostosis (DISH) was present in 8% and Dupuytren’s Contracture was present in 9.5%.

There were significant overlapping in different Rheumatological manifestations and many of the patients had more than one musculoskeletal manifestation.

Duration of diabetes had been strongly associated with Osteoarthritis and DISH (p-value <0.005). Our study did not find significant association with HBA1c level like in other studies probably because of small sample size.


  Conclusion Top


Our study shows most common rheumatological manifestation in Diabetes Mellitus are Osteoarthritis, Frozen shoulder and Limited joint Mobility. Our study shows duration of diabetes is an important risk factor for development of rheumatological manifestations.



 
  References Top

1.
Agrawal et al. Prevalance of rheumatological manifestation in Diabetic population from north-west India. JAPI.2014; 62:16-20.  Back to cited text no. 1
    
2.
Sarkar et al. Rheumatological manifestations of diabetes mellitus. J ind Rheumatol Assoc. 2003;11:25-29.  Back to cited text no. 2
    
3.
Badal Pal. Rheumatic disorders and bone problems in diabetes mellitus. Text Book of Diabetes2. Edited by John C Pickup and Garath Williams. Third edition. Blackwell publishing.  Back to cited text no. 3
    
4.
Mathew et al. Rheumatic- musculoskeletal manifestations in type 2 diabetes mellitus patients in south India. Int J Rheum Dis 2011;14:55-60.  Back to cited text no. 4
    
5.
Pottie et al. Obesity and Osteoarthritis: more complex than predicted. Ann Rheum Dis.2006;65:1403-5.  Back to cited text no. 5
    
6.
Kumar et al. Rheumatological Manifestations in Diabetes Mellitus: Distribution And Associated Factors. IOSR- JDMS.2016;15:51-54.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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  In this article
Abstract
Introduction
Aims & Objective
Material and Methods
Inclusion Criteria
Results
Discussion
Conclusion
References
Article Tables

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