AB1230 PERIPHERAL ARTERY DISEASE AND JOINT PAIN IN TYPE 2 DIABETES PATIENTS, FROM ASSOCIATION TO CAUSATION
Authors: E. Shalaeva, A. Shalaeva, N. Dadabaeva, K. Mirakhmedova
Journal: Annals of the Rheumatic Diseases (2020)

Background: Type 2 diabetes mellitus (T2DM) and arthritis are considered two separate conditions. However, inflammation and metabolic changes play a major role in diabetes co-morbidity (1). The pathogenesis of the joint pain and stiffness in diabetes patients is not fully understood. Diabetic osteoarthropathy (neuropathic arthropathy) considers a quite rare condition (0.1–0.4% of diabetic patients), involving destructive, lytic joint changes (2). Interestingly, over 52% of diabetic patients have joint diseases, compare to only 27% without diabetes; and people with arthritis have over 60%higher risk of diabetes development (3). Objectives: The purpose of the study was to determine the association between the lesions of low extremity arteries (LEA) and the prevalence of arthritis (joint pain and stiffness) among patients with type 2 diabetes. Methods: This is the pilot analysis of the musculoskeletal data obtained from the prospective cohort study of patients with diabetes complications 2013-2016 (179 consecutive T2DM pts undergoing transfemoral amputation (TFA) due to gangrene of lower limb (4,5), and 199 patients experienced balloon angioplasty (BA) of the LEA (without gangrenes). The computer tomography angiography was performed, along with clinical, laboratory and instrumental examination. Functional class of joint lesions (hip, knee or foot) was obtained based on self-service and (un)professional activity. Results: All observed patients had diabetic neuropathy. The affected extremity in all the patients undergoing TFA had critical arterial ischemia along with foot gangrene, knee/hip pain, stiffness and rigidity. The second extremity also had stenoses of popliteal, anterior or posterior tibial arteries and the severity of stenoses was positively correlated with the severity of muscle and joints pain (r=0.771, p&lt;0.001). Among 199 patients without gangrene of lower limb, BA was done on superficial femoral artery 46 (23.1%) patients, popliteal in 44 (22.1%), posterior tibial 54 (27.1%), arterial tibial 41 (20.6), and peroneal artery 14 (7%). At least 1 large and 1 small joint was affected per person. The correlation between the prevalence of joint pain/stiffness and peripheral artery stenosis of the same lower extremity in patients without gangrene was significant r=0.632, indicating a large positive relationship (approximately 39.9% of the total variance). A linear regression analysis was conducted to evaluate the association between the severity of artery lesions and the severity of joint functional class, F (1, 198) = 57.82, p &lt;0.001, t = 7.91, p &lt; 0.001. The 95% confidence interval for the slope was 0.71 to 1.29, which did not include the value of zero. Conclusion: The results show that the more severe the peripheral artery stenosis was the more prevalent join lesions are and worsen the function class. However, more studies are needed. References: [1]Shalaeva E.V. et al. Impact of purulent complications and sepsis on cardiovascular system in patients with type 2 diabetes. Critical Care 2014, 18(Suppl 2):P6; doi:10.1186/cc14009 [2]Kim R.P., et al. Musculoskeletal Complications of Diabetes Mellitus. Clinical Diabetes. 2001, 19 (3) 132-135; DOI: 10.2337/diaclin.19.3.132 [3]Piva S.R., Susko A.M. et al. Links between Osteoarthritis and Diabetes:Implications for Management from a Physical Activity Perspective. [4]Shalaeva E.V., Saner H, et al. Coronary artery calcium score and coronary computed tomographic angiography for major perioperative cardiovascular complications in symptomatic diabetic patients undergoing trans-femoral amputation. International Journal of Cardiology 221 (2016) 806–811. http://dx.doi.org/10.1016/j.ijcard.2016.06.165 Disclosure of Interests: None declared