Rheumatic Manifestations of Diabetes Mellitus

doi:10.1016/j.rdc.2010.09.008

Rheumatic Disease Clinics of North America

Volume 36, Issue 4, November 2010, Pages 681-699

https://doi.org/10.1016/j.rdc.2010.09.008 Get rights and content

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Limited Joint Mobility (Diabetic Cheiroarthropathy)

Hand stiffness as a complication of DM was first described in 1957 by Lundbaek in 5 adults with insulin-dependent DM¹⁰ and subsequently in 1974 by Rosenbloom in 3 adolescents with type 1 DM.¹¹ The term cheiroarthropathy (derived from the Greek word cheiros, meaning hand) also has been used to describe this condition; however, use of the term arthropathy is inaccurate, because the pathologic process involves periarticular structures, not the joint itself.

Rosenbloom and colleagues¹¹ described 3

Diabetic muscle infarction

DMI is an infrequent complication of DM that was first described in 1965 by Angervall as “tumoriform focal muscular degeneration.”⁷⁵ Since its initial description, more than 100 cases have been reported.76, 77 More than half of these reported patients with DMI had type 1 DM with a mean duration of 15 years.

DMI almost always presents with the acute onset of muscle pain and swelling. The thigh muscles are most frequently involved in more than 80% of cases, but isolated calf muscle, simultaneous

Neuropathic osteoarthropathy (Charcot osteoarthropathy, Charcot neuropathic arthropathy)

Neuropathic osteoarthropathy is a progressive, degenerative arthropathy associated with various diseases in which neuropathy occurs. In 1868, Charcot published a detailed description of this condition among patients with tabes dorsalis.⁸³ Subsequently, his name has been associated with the joint condition characterized by an inflammatory process that results in dislocation of the neuropathic joint and fracture and resorption of affected bones.

DM is the disease most commonly associated with

Diffuse idiopathic skeletal hyperostosis (Forestier's disease)

DISH is characterized by the calcification and ossification of ligaments and entheses. When first described in 1950 by Forestier and Rotes-Querol, it was called senile ankylosing hyperostosis of the spine. This name reflected its higher prevalence among older individuals, in contrast to ankylosing spondylitis, and its predilection for involving the axial skeleton, most often the thoracic spine.⁹³ Because this condition also can involve appendicular joints, the term DISH was introduced in 1976

Gout

In patients with gout, monosodium urate crystals are deposited in joints as a result of hyperuricemia. Acute attacks of gouty arthritis occur when intra-articular monosodium urate crystals are phagocytized by white blood cells that then release inflammatory mediators. The relationships between hyperuricemia, gout, and the metabolic syndrome have been evaluated in several cross-sectional studies. Epidemiologic studies have shown a higher prevalence of the metabolic syndrome among patients with

Osteoarthritis

Obesity is a known risk factor of the development of hip¹²³ and knee OA.124, 125, 126 Despite the association of type 2 DM and the metabolic syndrome with obesity, there is no clinical evidence that DM or the metabolic syndrome predispose an individual to develop early or severe hip or knee OA.¹²⁷ However, there are features common to the pathogenesis of OA and of diabetic microvascular complications, such as AGEs and adipokinins.

In vitro, AGE modification increases the stiffness of normal

Summary

DM is associated with various musculoskeletal manifestations. The strength of this relationship varies among the various musculoskeletal disorders; the associations are based mostly on epidemiologic data. For most of these conditions, definitive pathophysiologic correlates are lacking.

Hand and shoulder disorders occur more frequently than other musculoskeletal manifestations of DM. Recognition of the association between DM and shoulder adhesive capsulitis, DD, and stenosing flexor tenosynovitis

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