- Email: [email protected]
49. Limited joint mobility in patients with diabetes mellitus
Abstracts/Netherlands
Journal
signs is uncertain. The purpose of our study was to obtain the prevalence of neuromuscular signs in thyroid dysfunction, and the effect of treatment. Methods: Twenty-one patients with hypothyroidism and 14 patients with hyperthyroid&m were studied. We obtained a history and physical examination, focussing on neuromuscular symptoms, before treatment, after 3 months and after 1 year of therapy. Strength of 10 major muscle groups was quantified by means of a hand-held dynamometer, and electromyography and nerve conduction studies were performed. Results: Hypotbyroidism: Mean age 48 years (range 24-76 years), 86% female. 76% had muscle complaints, whereas in 14% this was the presenting symptom. Neuropathic complaints were present in 38%. Also 38% of the patients with hypothyroidism had decreased muscle strength, especially of the proximal muscles. Neurophysiological studies showed myopathic changes in 33%, neuropathic changes in 19% and a carpal tunnel syndrome also in 19%. During treatment the muscle complaints disappeared in 69% of the patients after an average time of 5 months. The hand-held dynamometer showed only a 12% increase of muscle strength (P - 0.006, paired t-test). Hyperthyroidism: Mean age 44 years (range 22-75 years), 71% female. 64% had muscle complaints, whereas in 29% this was the presenting symptom. Neuropathic complaints were present in 21%. 57% had decreased muscle strength, also especially of the proximal muscles. Neurophysiological studies showed myopathic changes in 14% and neuropathic changes in 29%. During treatment the muscle complaints disappeared in all patients after an average time of 5 months; sensory complaints also disappeared in all patients after an average time of 7 months. Unexpectedly, the hand-held dynamometer showed an increase of muscle strength of 30% (P = 0.0001, paired t-test). Conclusions: Our study shows that among patients with both hypo- and hyperthyroidism clinical apparent myopathy is present in the majority of cases and neuropathy in l/3 of the patients. After treatment resulting in euthyroidism neuromuscular complaints disappeared in more than 70% of the patients with both hypo- and hyperthyroidism. 48. Uncoupling of bone formation and women with hip fractures. A prospective
bone resorption in study. P.L.A. van Daele, J.C. Birketitiger, A. Hofman, H.A.P. Pols. Department of Internal Medicine, Menwde Hospiial, Dordrecht; Department of Inrernal Medicine III, Dijkzigt Hospital, Rotterdam, Netherlands.
Purpose: To examine whether sensitive markers of bone turnover are associated with the occurrence of hip fractures. Methods: Design: Nested case control study within the Rotterdam Study. Population: cases - 36 women with an incident hip fracture following baseline assessments; controls - 163 women without a hip fracture in the follow-up. Follow-up time - 2.4 years (1.5 to 3.0). Measurements - bone formation, osteocalcin (Incstarh bone resorption, Pyrilinks-D (Metra Biosystems). Results: Women with an osteocalcin level below the median had a 3.1 times (95% CI 1.0-9.2) higher risk for getting a hip fracture than those with a level above the median. Furthermore, women with a Pyrilinks-D level above the median had 3.9 times (1.3-l 1.9) higher risk than those with a level below the median. From the women with a Pyrilinks-D level above the median and a hip fracture, 44.4% had an osteocalcin level within the lowest
of Medicine
50 (1997)
Al9
Al -A44
tertile compared to 15.8% of the women with a Pyrilinks-D level above the median without a hip fracture (P = 0.01). Conclusions: Low osteocalcin levels and high Pyrilinks-D levels are associated with an increased risk for hip fractures. In addition, the present findings suggest that there may be an uncoupling between bone formation and bone resorption in elderly women, leading to an increased hip fracture risk. 49. Liited
joint
mobility
in patients
with
diabetes
mellitus.
R.J. Erdtsieck I, M. van der Laan’,*, M.L. Jacobs ‘, R.F.A. Weber ‘. J.W.F. Elte 2. I Department of Internal Med. III, AZR Dijkzigt, Rotterdam Franciscus Gasthuis,
and 2 Department of Internal Rotferdam, Netherlands.
Medicine,
Sint
Limited joint mobility (LJM) is caused by an increase of abnormal connective tissue in the skin, especially in the surroundings of the joints, resulting in decreased mobility. Patients suffering from LJM often complain of a painful shoulder, decreased mobility in the hip and stiff hands. LJM has recently been recognized as a complication in diabetes mellitus. In patients with diabetes mellitus a prevalence of up to 50-70% has been suggested. In this cross-sectional study we examined the prevalence of LJM in a group of 265 patients with diabetes mellitus compared to controls (n = 49, 22 male and 27 female). Of the 265 patients, 138 were considered to suffer from IDDM (79 male and 59 female) and 127 from NIDDM (52 male and 7.5 female). Various parameters were noted: i.e.. medication, smoking, menopausal state, duration and complications of diabetes mellitus and the level of glycosylated hemoglobin. Special attention was given to the mobility of the joints, presence of Dupuytren contracture and/or the presence of a trigger finger and paresthesia in the hand. Also the mobility of the phalangeal joints was measured and scored. The presence of a positive Prayer’s sign was noted (i.e., the inability to approximate the palmar surfaces completely). All subjects were interviewed by using a structured questionnaire with respect to daily functions. Statistical analysis was performed by means of SPSS. The groups were comparable as to age, sex and race. Significant differences between the patients and the controls were found for the presence of Dupuytren contracture and the presence of Prayer’s sign at both digitus II and V (P < 0.01). la the patients with NIDDM Dupuytren contracture was observed more frequently as was the Prayers’s sign in digitus II (P < O.Ol), compared to patients with IDDM. The presence of complications (i.e., neuropathy, retinopathy or nephropathy) was related to the presence of LJM. In women with diabetes mellitus more often complaints related to LJM or restrictions in joint mobility were found. compared to men with diabetes mellitus. The conclusion of this cross-sectional study is that I..JM is present if the Prayer’s sign at digitus iI and V is more than 0 mm. Also other complaints with regard to joints were observed more often in the patient groups, which were related to \ex and other complications (of diabetes mellitus). 50. Evaluation
of diabetic
education. E. of Internal Netherlands.
footcare
Hoff, J. Dooren, K. Bakker. Department Spaame
Ziekenhuis,
Heemstede,
Gijker, C.E. Medicine.
Journal
signs is uncertain. The purpose of our study was to obtain the prevalence of neuromuscular signs in thyroid dysfunction, and the effect of treatment. Methods: Twenty-one patients with hypothyroidism and 14 patients with hyperthyroid&m were studied. We obtained a history and physical examination, focussing on neuromuscular symptoms, before treatment, after 3 months and after 1 year of therapy. Strength of 10 major muscle groups was quantified by means of a hand-held dynamometer, and electromyography and nerve conduction studies were performed. Results: Hypotbyroidism: Mean age 48 years (range 24-76 years), 86% female. 76% had muscle complaints, whereas in 14% this was the presenting symptom. Neuropathic complaints were present in 38%. Also 38% of the patients with hypothyroidism had decreased muscle strength, especially of the proximal muscles. Neurophysiological studies showed myopathic changes in 33%, neuropathic changes in 19% and a carpal tunnel syndrome also in 19%. During treatment the muscle complaints disappeared in 69% of the patients after an average time of 5 months. The hand-held dynamometer showed only a 12% increase of muscle strength (P - 0.006, paired t-test). Hyperthyroidism: Mean age 44 years (range 22-75 years), 71% female. 64% had muscle complaints, whereas in 29% this was the presenting symptom. Neuropathic complaints were present in 21%. 57% had decreased muscle strength, also especially of the proximal muscles. Neurophysiological studies showed myopathic changes in 14% and neuropathic changes in 29%. During treatment the muscle complaints disappeared in all patients after an average time of 5 months; sensory complaints also disappeared in all patients after an average time of 7 months. Unexpectedly, the hand-held dynamometer showed an increase of muscle strength of 30% (P = 0.0001, paired t-test). Conclusions: Our study shows that among patients with both hypo- and hyperthyroidism clinical apparent myopathy is present in the majority of cases and neuropathy in l/3 of the patients. After treatment resulting in euthyroidism neuromuscular complaints disappeared in more than 70% of the patients with both hypo- and hyperthyroidism. 48. Uncoupling of bone formation and women with hip fractures. A prospective
bone resorption in study. P.L.A. van Daele, J.C. Birketitiger, A. Hofman, H.A.P. Pols. Department of Internal Medicine, Menwde Hospiial, Dordrecht; Department of Inrernal Medicine III, Dijkzigt Hospital, Rotterdam, Netherlands.
Purpose: To examine whether sensitive markers of bone turnover are associated with the occurrence of hip fractures. Methods: Design: Nested case control study within the Rotterdam Study. Population: cases - 36 women with an incident hip fracture following baseline assessments; controls - 163 women without a hip fracture in the follow-up. Follow-up time - 2.4 years (1.5 to 3.0). Measurements - bone formation, osteocalcin (Incstarh bone resorption, Pyrilinks-D (Metra Biosystems). Results: Women with an osteocalcin level below the median had a 3.1 times (95% CI 1.0-9.2) higher risk for getting a hip fracture than those with a level above the median. Furthermore, women with a Pyrilinks-D level above the median had 3.9 times (1.3-l 1.9) higher risk than those with a level below the median. From the women with a Pyrilinks-D level above the median and a hip fracture, 44.4% had an osteocalcin level within the lowest
of Medicine
50 (1997)
Al9
Al -A44
tertile compared to 15.8% of the women with a Pyrilinks-D level above the median without a hip fracture (P = 0.01). Conclusions: Low osteocalcin levels and high Pyrilinks-D levels are associated with an increased risk for hip fractures. In addition, the present findings suggest that there may be an uncoupling between bone formation and bone resorption in elderly women, leading to an increased hip fracture risk. 49. Liited
joint
mobility
in patients
with
diabetes
mellitus.
R.J. Erdtsieck I, M. van der Laan’,*, M.L. Jacobs ‘, R.F.A. Weber ‘. J.W.F. Elte 2. I Department of Internal Med. III, AZR Dijkzigt, Rotterdam Franciscus Gasthuis,
and 2 Department of Internal Rotferdam, Netherlands.
Medicine,
Sint
Limited joint mobility (LJM) is caused by an increase of abnormal connective tissue in the skin, especially in the surroundings of the joints, resulting in decreased mobility. Patients suffering from LJM often complain of a painful shoulder, decreased mobility in the hip and stiff hands. LJM has recently been recognized as a complication in diabetes mellitus. In patients with diabetes mellitus a prevalence of up to 50-70% has been suggested. In this cross-sectional study we examined the prevalence of LJM in a group of 265 patients with diabetes mellitus compared to controls (n = 49, 22 male and 27 female). Of the 265 patients, 138 were considered to suffer from IDDM (79 male and 59 female) and 127 from NIDDM (52 male and 7.5 female). Various parameters were noted: i.e.. medication, smoking, menopausal state, duration and complications of diabetes mellitus and the level of glycosylated hemoglobin. Special attention was given to the mobility of the joints, presence of Dupuytren contracture and/or the presence of a trigger finger and paresthesia in the hand. Also the mobility of the phalangeal joints was measured and scored. The presence of a positive Prayer’s sign was noted (i.e., the inability to approximate the palmar surfaces completely). All subjects were interviewed by using a structured questionnaire with respect to daily functions. Statistical analysis was performed by means of SPSS. The groups were comparable as to age, sex and race. Significant differences between the patients and the controls were found for the presence of Dupuytren contracture and the presence of Prayer’s sign at both digitus II and V (P < 0.01). la the patients with NIDDM Dupuytren contracture was observed more frequently as was the Prayers’s sign in digitus II (P < O.Ol), compared to patients with IDDM. The presence of complications (i.e., neuropathy, retinopathy or nephropathy) was related to the presence of LJM. In women with diabetes mellitus more often complaints related to LJM or restrictions in joint mobility were found. compared to men with diabetes mellitus. The conclusion of this cross-sectional study is that I..JM is present if the Prayer’s sign at digitus iI and V is more than 0 mm. Also other complaints with regard to joints were observed more often in the patient groups, which were related to \ex and other complications (of diabetes mellitus). 50. Evaluation
of diabetic
education. E. of Internal Netherlands.
footcare
Hoff, J. Dooren, K. Bakker. Department Spaame
Ziekenhuis,
Heemstede,
Gijker, C.E. Medicine.