Rheumatic complications in patients with diabetes mellitus

Abstract

Epidemiological data indicate that rheumatic complications are prevalent in patients with diabetes mellitus, with a diagnosis rate of 30–70 %. Chronic hyperglycemia induces significant structural and functional alterations in bone, cartilage, and muscle tissues, attributable to the accumulation of advanced glycation end-products, oxidative stress, microangiopathy, and neuropathy. Diabetic osteoarthropathy is particularly noteworthy due to its progressive nature and high likelihood resulting in disability. Diabetic cheiroarthropathy presents with characteristic contractures and deformities of the hand joints, pathogenetically linked to fibrosis processes associated with prolonged hyperglycemia. Compression neuropathy, resulting from ischemia of nerve fibers, is characterized by severe pain syndrome and sensory disturbances. Adhesive capsu-litis is defined by progressive fibrosis of the joint capsule, leading to significant functional impairment of the shoulder joint. Sclerede-ma diabeticorum manifests as pathological thickening of the skin, resulting in restricted mobility due to excessive extracellular matrix deposition. Metabolic dysregulation is implicated in the development of gout. Osteoarthritis exhibits an accelerated course, driven by rapid degradation of cartilage tissue due to protein glycation and chronic inflammatory processes. The co-occurrence of rheumatoid arthritis and diabetes mellitus is marked by the rapid progression of joint deformities and a severe clinical course. Muscle infarc-tions, secondary to diabetic angiopathy, present with acute pain syndrome and restricted motor function. Idiopathic hyperostosis involves pathological proliferation of bone tissue, predominantly in the spine. Osteoporotic fractures arise from reduced bone mineral density and increased bone fragility. Diagnosing musculoskeletal disorders in diabetes mellitus necessitates a comprehensive ap-proach, incorporating clinical examination, radiographic imaging, magnetic resonance imaging, ultrasound examination, densitome-try, and laboratory tests. The therapeutic strategy focuses on optimal glycemic control, pathogenetic and symptomatic pharmacotherapy, physiotherapy approaches, rehabilitation programs, and, when indi-cated, surgical interventions. Prevention focuses on the early identi-fication of complications, achievement of target metabolic control parameters, minimization of traumatic injuries, and maintenance of optimal physical activity.