Lower Limb Enthesopathy in Patient with Diabetes Mellitus without Clinical Signs of Arthropathy

Abstract

Background: Diabetes mellitus is a leading cause of death and disability worldwide. Its global prevalence was about 8% in 2011 and is predicted to rise to 10% by 2030. DM has great impact on the connective tissue and prolongation of diabetes period increases the degree of complications. Musculoskeletal ultrasonography using the Glasgow Ultrasound Enthesitis Scoring System (GUESS) is a validated and useful tool to quantify articular and periarticular changes of lower extremity. Objectives: The objective of this study is to findout the correlation between Glasgow Ultrasound Enthesitis Score in diabetic patients and duration of DM.
Materials and Methods: This Cross sectional study was carried out in the Department of Radiology and Imaging, BIRDEM, Dhaka, during July 2017 to June 2019 period. For this purpose, a total of 120 diabetic patients were included in this study. Observation and Results: Results revealed the mean age (±SD) was 49.46±7.99 years ranging from 35-64 years. Male to female ratio was 1:1.1. There was positive significant correlation found between duration of DM with the suprapatellar bursitis (r=0.637; p=0.001), infrapatellar bursitis (r=0.319; p=0.001) retrocalcaneal bursitis(r=0.715;p=0.001), quadriceps tendon thickness (r=0.583;p=0.001), proximal patellar ligament thickness(r=0.441;p=0.001) and Achilles tendon thickness (r=0.343;p=0.001). On the other hand, there was a negative correlation (r=-0.176; p=0.055) was found between the plantar aponeurosis thickness with duration of DM. There was a significant positive correlation (r=0.941; p=0.001) was found between the total GUESS score with duration of DM. There was also a positive correlation was found between duration of diabetes with total enthesophyte score (r=0.734; p=0.001) and total erosion score (r=0.791; p=0.001). The receiveroperator characteristic (ROC) curves of duration of DM had area under curve 0.988; 95% confidence interval, 0.974–1.00, with a cut off value 20 years having 57.6% sensitivity and 100.0% specificity for prediction of severe entheseal damage. Conclusion: This study indicates that Ultrasonographic evaluation of lower extremity entheseal sites in diabetic patient by using Glasgow Ultrasound Enthesitis Scoring System (GUESS) significantly correlated with duration of diabetes.