Rheumatological and Musculoskeletal Complications in Diabetes Patients

Abstract

Musculoskeletal disorders are common in individuals with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). It is associated with significant morbidity and hampered quality of life. Hyperglycemia-induced aberrant levels of insulin or insulin growth factors may lead to neuropathic complications, which enhances pain through central sensitization. Evidence suggests that diabetes is associated with numerous musculoskeletal disorders and inefficient control of diabetes may cause persistent musculoskeletal pain over time. Neuropathic joints are commonly observed in the foot and ankle of patients. Diabetic polyneuropathy, rheumatoid arthritis (RA)-associated pain are other complications. In diabetic patients with osteoarthritis (OA), factors including advanced glycation end-stage products (AGEs) and markers of oxidative stress could contribute to pain associated with low-grade inflammation. In obese individuals with T2DM, uncontrolled glycemic status can lead to mechanical stress-induced calcification and ossification of ligaments, and oxidative damage. In individuals with diabetes and OA, synovitis in the tissues is evidenced by the presence of higher levels of prostaglandins, leukotrienes, and adipokines. The pathogenesis of cheirarthritis remains largely unknown and is attributed to increased AGE, chronic hyperglycemia, dysregulated function of extracellular and some intracellular proteins. Advancing age, hormonal changes during adolescence, disorderly secretion of growth hormone and insulin-like growth factor-1 (IGF-1) are other possible contributing factors. Early assessment and strict control of diabetes can prevent other long-term micro and macrovascular complications. These measures can reduce the term of enduring pain and morbidity in susceptible individuals. This article reviews the prevailing knowledge and the mechanistic role of underlying diabetes on rheumatological and musculoskeletal disorders.

J Endocrinol Metab. 2022;12(4-5):117-124
doi: https://doi.org/10.14740/jem811