| Abstract | Globalno gledano, šećerna bolest (DM) je veliki javnozdravstveni problem koji uzrokuje funkcionalnu nesposobnost među oboljelima. Dok su vaskularne komplikacije DM dobro poznate i predstavljaju glavni uzrok mortaliteta i morbiditeta, mišićno-koštane (MSK) manifestacije DM su česte i iako nisu opasne po život, važan su uzrok morbiditeta, boli i invaliditeta. Pojedina su stanja specifična za osobe oboljele od šećerne bolesti, dok su druga prisutna u općoj populaciji, ali imaju veću prevalenciju u populaciji bolesnika sa šećernom bolešću. Točna patofiziologija većine MSK poremećaja ostaje nejasna. U pozadini povećane učestalosti MSK poremećaja kod DM mogu biti neuropatija, poremećaji vezivnog tkiva, vaskulopatija ili kombinacija navedenih problema. Najvažniji rizični čimbenik za MSK poremećaje kod bolesnika s DM je dugotrajna i nekontrolirana hiperglikemija. MSK manifestacije DM uključuju dijabetičku heiroartropatiju, palmarni fasciitis s posljedičnom Dupuytrenovom kontrakturom prstiju šake, stenozirajući fleksorni tenosinovitis šake (tzv. škljocavi prst), adhezivni kapsulitis ramena (tzv. smrznuto rame), osteoartritis perifernih zglobova i kralježnice (Morbus Forestier ili DISH), osteoporozu (tzv. dijabetoporozu), sarkopeniju, neuropatiju (perifena kompresivna neuropatija najčešće kao sindrom karpalnog kanala, polineuropatija najčešće kao simetrična distalna senzomotorna polineuropatija, dijabetička amiotrofija ili dijabetička lumbosakralna radikulopleksopatija), dijabetička osteoartropatija ili neuropatska artropatija (Charcotov zglob) i posttraumatski regionalni bolni sindrom. Dijagnoza MSK poremećaja u DM postavlja se prvenstveno kliničkim pregledom. U pojedinim slučajevima dodatno se vrše radiološke, elektrofiziološke, laboratorijske i druge pretrage, važne u diferencijalnoj dijagnozi. Trenutno ne postoji specifično liječenje za takva stanja. Ublažavanje simptoma i komplikacija provodi se konzervativnim i/ili kirurškim načinom. Važnu ulogu ima fizikalna terapija. Obzirom da je DM, kao temeljnu bolest bez pridodanih komplikacija i poremećaja, lakše liječiti, stroga kontrola glikemije, pravovremeno prepoznavanje i zbrinjavanje MSK manifestacija DM važan je dio skrbi za pacijente oboljele od DM. U prevenciji i liječenju MSK poremećaja ključni faktor je optimalno upravljanje metabolizmom ugljikohidrata. |
| Abstract (english) | Globally, diabetes mellitus (DM) is a major public health problem, causing functional disability among those affected. While vascular complications of DM are well known and represent a major cause of mortality and morbidity, musculoskeletal (MSC) manifestation of DM are common and, although not life-threatening, are an important cause of morbidity, pain, and disability. Some conditions are specific to people who are suffering from diabetes, while others are more distributed throughout the common population, but are still more prevalent in patient with diabetes. The exact pathophysiology of most MSK remains unclear. Connective tissue disorders, neuropathy, vasculopathy or a combination of these problems may be behind the increased frequency of MSK in DM. The most important risk factor for musculoskeletal disorders in patients with diabetes mellitus is long-term and uncontrolled hyperglycemia. MSK manifestations of DM include diabetic cheiroarthropathy, palmar fasciitis with consequent Dupuytren's contracture of the fingers of the hand, flexor tenosynovitis, known as a “trigger finger, adhesive capsulitis of the shoulder (so-called frozen shoulder), osteoarthritis of the peripheral joints and spine (Morbus Forestier or DISH), osteoporosis (so-called diabetes mellitus), sarcopenia, neuropathy (peripheral compressive neuropathy most often as carpal tunnel syndrome, polyneuropathy most often as symmetrical distal sensorimotor polyneuropathy, diabetic amyotrophy or diabetic lumbosacral radiculoplexus neuropathy, diabetic osteoarthropathy or neuropathic arthropathy (Charcot joint) and post-traumatic regional pain syndrome. A diagnosis of musculoskeletal dysfunctions in diabetic patients is made by clinical findings. In some cases, radiological, electrophysiological, laboratory and other tests, important in differential diagnosis, are additionally performed. No specific treatment for the disorders is available at the moment. Alleviation of symptoms and complications is carried out conservatively and/or surgically. Physical therapy plays an important role. Since DM, as a basic disease without added complications and disorders, is easier to treat, strict glycemic control, timely recognition and treatment of MSK manifestations of DM is an important part of care for patients suffering from DM. Optimal management of carbohydrate metabolism is essential in the prevention and treatment of MSK disorders. |
