How does diabetes affect joints?

Diabetes mellitus is associated with metabolic disorders, so the cartilage in diabetics is more likely to age and deteriorate. Due to impaired blood circulation during vasoconstriction, the innervation of muscles and ligaments is disturbed, lack of nutrition negatively affects their main function – to fix and strengthen the joints.

In addition, excess glucose builds up on the surface of the joints, making it difficult for them to move, reduces flexibility, makes them stiffer, and also destroys the collagen that make up the tendons. Being overweight with diabetes puts additional pressure and aggravates pain in the joints of the legs. Insufficient insulin production leads to pathological changes in muscles, bones and joints.

The clinical picture of endocrine diseases also includes signs of damage to the musculoskeletal system. It is extremely important to timely identify the secondary nature of arthropathy , because timely correction of endocrine pathology can not only slow down the process of destruction, but also reverse it.

Metabolic disorders, neurological and vascular complications of diabetes mellitus lead to pathological changes in all organs and systems, including the osteoarticular system. Diabetic arthropathies are a frequent complication of diabetes, occurring, according to various sources, in 58% of patients with type I diabetes mellitus and in 24% of patients with type II diabetes mellitus. Complications of diabetes mellitus of a specific nature, similar to diabetic osteoarthropathy , are found in 5–23% of diabetics, while limited joint mobility is present in 42.9% of patients with type I diabetes and in 37.7% of patients with type II diabetes.

Hyperglycemia is the main reason for the development of late complications of diabetes, which include pathologies of the osteoarticular system. Excess blood sugar has a toxic, damaging effect on the structure of organs and tissues.

In hyperglycemia, glucose metabolism proceeds with increased formation of sorbitol, which poorly penetrates cell membranes, accumulates in cells and disrupts their functions, provoking the development of diabetic neuropathy . Insulin deficiency leads to pathological changes in bone and cartilage tissue.

The clinic of complications of diabetes in the osteoarticular system is very diverse and resembles lesions in rheumatism.

Diabetic osteoarthropathy

It is believed that such a pathology can occur in diabetics suffering from this disease for 5–8 years in the absence of systematic treatment of diabetes. With the help of ultrasound osteometry , the primary signs of diabetic osteoarthropathy can be detected in about 66% of patients. In this case, the joints of the lower extremities are more often affected (as a rule, the tarsometatarsal (60% of patients), metatarsophalangeal (30%), ankle (10%), less often the knee and hip). The process is usually one-sided, but in 20% of cases it is also two-sided.

Diabetic foot

With diabetic osteoarthropathy, there is pain in the affected joints, their deformation, and sometimes edema. Often, pain syndrome is insignificant or absent, despite significant changes detected on radiography. It is associated with neuropathy and numbness associated with the disease. Usually these changes are localized in the metatarsal bones. Due to impaired sensitivity, sprains and instability of the arch of the foot, osteolysis (accelerated destruction of the phalangeal bones) can occur , which can lead to deformation of the foot and its shortening.

Diabetic foot syndrome is a pathology of the feet in a diabetic, resulting from damage to peripheral nerves, as well as blood vessels, soft tissues, joints, bones. SDS creates a prerequisite for the formation of acute or chronic ulcers, purulent-necrotic processes, osteoarticular lesions. This problem is detected in 10-25% of patients with diabetes mellitus, and according to other data, in different forms – in 30-80%. Typically, diabetic foot syndrome occurs on the background of long-term (over 15 years) diabetes, usually in the elderly. The number of lower limb amputations in diabetics is 70% of the total number of non-traumatic amputations, and the death rate after amputation in the first year is 30% higher than in patients without diabetes. The incidence of diabetic foot syndrome is in direct proportion to the severity and duration of the underlying disease. 

Pathological changes in the osteo-ligamentous apparatus of the feet can develop for months, the result will be a pronounced deformation of the bones. In this case, clinical manifestations include hyperthermia (overheating with an increase in temperature) of the foot and its swelling. At the initial stages, pain syndrome is observed, which suggests the appointment of diagnostic studies aimed at excluding acute thrombophlebitis or acute gouty arthritis of the lower extremities.

After the first symptoms appear, bone changes progress for several months. Flattening of the foot, pathological mobility in the joints are observed. In the later stages, pain is absent, due to the development of severe neuropathy .

Orthopedic shoes are recommended for severe deformities of the foot. In extremely severe cases, they resort to surgery.

Syndrome of limited joint mobility (OPS) is a restriction of movement of small, less often large joints. Clinically, OPS is manifested by pain during movement of the joints, usually the metacarpophalangeal and proximal interphalangeal joints. Sometimes damage to the shoulder, elbow, wrist, ankle joints is possible. 

It is difficult for a patient with OPS to fold both hands tightly together (“praying hands” syndrome), which is the determining factor of this complication. Quite often, OPS is observed against the background of other rheumatic disorders, this condition is called “diabetic arthropathy of the upper extremities.”

The appearance of OPS in patients with diabetes mellitus completely depends on the duration of the underlying disease and the degree of its compensation (usually manifests itself after 4–6 years, if the level of glycated hemoglobin is 8.1–12.2% and is accompanied by retino and nephropathy). It is believed that in diabetics with OPS, the risk of nephropathy is 3.6 times higher, and proliferative retinopathy (with the formation of additional vessels in the retina) – 2.8 times.

Shoulder-scapular periarthritis is also a fairly common complication of diabetes mellitus. In the scientific literature, the expression “painful shoulder of a diabetic” is often found, which means a combination of humeral-scapular periarthritis and OPS syndrome, sometimes tenosynovitis (inflammation of the tendon sheaths) of the palms joins them . 

Diabetic brush

It is a late complication of diabetes, occurring in one third of patients. It leads to difficulty in the mobility of the fingers, hands, over which thick skin appears, usually on the back of the hand. Painful sensations are not typical. Conservative treatment is ineffective. Diabetic hand syndrome is difficult to treat, but daily palm stretching can help prevent or delay the development of the disease.

Osteoarthritis and inflammation of the periarticular bursa

There is no direct connection between arthrosis and diabetes mellitus, but it is often found in this pathology. In essence, this is an age-related deformity of the bony joints. The disease begins after 45 years, and with excess body weight – earlier. The bony joints of the legs are most affected. Arthrosis are of the following types:

• cervical;
• brachial;
• carpal;
• finger ;
• hip;
• knee;
• vertebrate;
• ankle;
• mixed.

Massage

Treatment of arthrosis in diabetes includes physiotherapy (electrophoresis, massage, pulse therapy, etc.). 

Bursitis is often found – inflammation of the periarticular bag, which has a bacterial nature. Each movement is accompanied by severe pain. Particular discomfort is the bursitis of the bony joints of the legs, since the lower extremities have the greatest load. The cause of bursitis is trauma, pressure on the joints. Diabetes is not the root cause, but it speeds up the process. Treatment of arthrosis and bursitis is a long process, therefore it is a serious medical problem.

Osteoporosis

Metabolic disorders caused by diabetes mellitus lead to a change in the processes of bone tissue remodeling , which, in case of insulin deficiency, leads to a violation of osteoblastic function. In diabetes mellitus, a decrease in the level of IGF-1, which is one of the main growth factors, is often found, which entails a decrease in the number of osteoblasts, as well as their activity.

Many studies in diabetes mellitus type I noted the presence of osteopenia . Some experts believe that osteopenia and osteoporosis are diffuse in 50% of diabetics. Systemic damage to bone tissue in such patients leads to an increased risk of fractures.

Fracture

Risk factors for the occurrence of osteopenic syndrome are considered to be:

• the manifestation of diabetes mellitus in persons under 20 years of age;
• experience of the disease over 10 years;
• prolonged decompensation of carbohydrate metabolism.

Diagnostics and treatment

MRI

Treatment of most of the above diseases is difficult, but there are techniques that minimize pain. Therefore, if such problems arise, it is advisable to consult a doctor in time. He will prescribe diagnostic measures:

• general inspection;
• collection of anamnesis;
• X-ray of the affected joint;
• MRI, biopsy (if necessary).

When joints begin to hurt with diabetes, the first step is to visit an endocrinologist. He will correct the treatment of the underlying disease, help compensate for carbohydrate metabolism, and then give recommendations to the traumatologist regarding the management of the patient, taking into account the type of disease, its duration, and the stability of the glycemic profile.

Therapy includes drugs that improve the rheology (viscosity) of the blood. This requires angioprotectors ( prodektina and others), desagregants ( Pentoxifylline , Ticlopidine and others), antiplatelet agents ( Aspikor , ticlopidine , and others). Physiotherapeutic procedures are widely used: massage, electrophoresis and others.

It is important to minimize stress on the joints. To eliminate pain, non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac and others) are prescribed . With infectious processes, there is a need for antibiotic treatment. Some foot problems require orthopedic shoes. Severe cases are subject to surgical treatment.

It should be noted that people with diabetes may have various manifestations of lesions of the musculoskeletal system. At the same time, especially severe disorders develop in persons with insulin-dependent diabetes. It should also be borne in mind that an important aggravating factor is considered to be overweight, which negatively affects all bony joints of the legs (especially diabetics are familiar with pain in the knee and ankle joints). Therefore, people diagnosed with diabetes should carefully monitor their weight, regularly visit an endocrinologist and follow all his recommendations for treatment.

Early diagnosis can help stop the further development of serious joint problems in diabetes.