Clinical features and risk factors of diabetes-associated osteoarthritis

Background. At present, data regarding the role of va­rious risk factors for the development of joint damage in patients with diabetes mellitus (DM) are extremely controversial. Particularly many questions remain regarding the clinical manifestations of this complication, since the development of diabetic arthropathies is a complex and multifaceted process that depends on the type of DM. The purpose of our study was to investigate the clinical features of diabetic arthropathy and to identify plausible risk factors for joint damage in patients with type 1 and 2 DM. Mate­rials and methods. Five hundred and fifty-six patients were divided into groups according to the type of DM, the presence and severity of diabetic arthropathy. Diagnosis of arthropathies was performed ­using the radiographic method and ultrasound of the joints. Results. In the group of patients with type 1 DM, arthropathy was diagnosed in 185 (74.5 %) cases, and in type 2 DM, joint lesions were detected in 241 (78.2 %) individuals. It was found that in the vast majority of patients with DM of both types, arthropathy was localized in the joints of the upper extremities. Most often, small distal or proximal joints of the hand and one of the large joints were involved in the pathological process. Oligoarthritis is characteristic of patients with type 1 DM, whereas polyarthritis is more common in patients with type 2 DM (t = 4.88, p ≤ 0.001). It was found that the risk of developing arthropathy in patients with type 1 DM increases significantly after 35 years, with body mass index (BMI) greater than 25.0 kg/m2, HbA1c levels higher than 8.0 %, and DM duration over 28 years. In patients with type 2 DM, the likelihood of developing arthropathy is increased in patients aged 61 years and older, with HbA1c levels greater than 8.2 %, BMI of 27.9 kg/m2 and above and the duration of diabetes more than 14 years. Conclusions. Preventive measures for diabetic arthropathy should be based on the maintenance of target HbA1c levels of less than 8 % for patients with type 1 DM and 8.2 % for people with type 2 DM, and BMI not higher than 25.0 kg/m2 for individuals with type 1 DM and 27.8 kg/m2 for those with type 2 DM.