Limited Joint Mobility in Diabetes and Ageing: Recent Advances in Pathogenesis and Therapy

Abstract

Limited joint mobility is frequently observed in elderly people and in patients suffering from diabetes, who represent a growing segment of the population of western countries. Our review wishes to offer the state of art about this interesting topic, which may have important clinical implications, leading to impairment of both basic and instrumental activities of daily living. The main causes of a reduced range of motion are degenerative joint diseases and increased stiffness of collagen tissue. The main biochemical abnormality, common to aging and diabetes, is the non-enzymatic glycosilation of collagen, with advanced glycation end product (AGE) formation, which in turn leads to an increase of collagen cross-links. The most extensive accumulation of AGEs occurs in tissues that contain proteins with low turnover, such as the collagen in the extracellular matrix of articular capsule, ligaments and muscle-tendon units. The increase in collagen cross-linking alters the mechanical properties of these tissues with a decrease in elasticity and tensile strength, and an increase in mechanical stiffness. Besides this, AGEs react with specific cell surface receptors (RAGEs). The engagement of the ligand by RAGEs triggers cell-specific signalling, resulting in enhanced generation of reactive oxygen species and sustained up-regulation of pro-inflammatory mediators and adhesion molecules. An appropriate control of the glucose levels and a diet rich in antioxidant agents are recommended in patients with diabetes. Stretching and strengthening programmes are widely used, in order to prevent and to reduce joint stiffness, but the improvements with physiotherapy are little and short-lasting. Several drugs, which can interfere with AGE formation and removal, or with the cellular effects of AGEs, are under study (among them pyridoxamine, an active form of Vitamin B6, AGE-breaker compounds, glucosamine, rutin and derivatives, soluble RAGE isoforms, and statins). In experimental animal models, these drugs are effective in reducing diabetic complications due to AGE formation; however, further study is necessary before their extensive use in the clinical setting.

Alterations of tendons in diabetes mellitus: what are the current findings?

“…Recently, a study by Abate et al [24] revealed the thickness of the supraspinatus tendon and the biceps tendon in asymptomatic elderly patients with diabetes, which were greater than that in controls by sonographic evaluation. Besides, they also found more sonographic appearances of degenerative features in the rotator cuff and biceps in DM subjects.…”

“…Patients with DM with poor glycaemic control often suffer from chronic pain, limited range of motion (ROM) of the joints and have a higher risk of tendon tears [10]. The prevalence of connective tissue diseases, such as Dupuytren's disease, trigger finger, carpal tunnel syndrome, rotator cuff tears and shoulder adhesive capsulitis (frozen shoulder), were increased in both patients with type 1 and type 2 diabetes [9,12,13].…”

“…What's more, the significant increase of fibrocartilage metaplasia and granulation tissue hyperplasia were reported in patients with diabetes with stenosing flexor tenosynovitis compared to those subjects without diabetes [39]. Local hypoxia, which is induced by rupture of collagen fibers, and disturbance of microcirculation, may contribute to calcifications [24]. Some studies suggested that calcifications might be attributed to the erroneous differentiation of tendonderived stem cells (TDSCs) towards to osteogenesis [40].…”

“…Epidemiological studies revealed higher prevalence of Dupuytren's disease, carpal tunnel syndrome and shoulder adhesive capsulitis in both type I and type II diabetic patients with poor glycaemic control [9,10]. Patients with insulindependent diabetes were significantly associated with chronic rotator cuff tendinitis and limited range of motion (ROM) in the shoulders [5].…”

Exercícios De Alongamento: Prescrição E Efeitos Na Função Musculoesquelética De Adultos E Idosos

“…Bons níveis de flexibilidade são extremamente importantes para a realização das atividades de vida diária (AVD), principalmente em pacientes com disfunções musculoesqueléticas (ABATE et al, 2010;WILLIAMSON et al, 2017). Esta importância torna-se ainda mais relevante na população idosa, uma vez que diversos estudos têm demonstrado a relação entre os níveis de flexibilidade e a independência funcional de idosos (ZOTZ et al, 2014;COSTA et al, 2013;GALLO et al, 2015).…”