1. Introduction

Worldwide, musculoskeletal (MSK) problems are prevalent and a primary source of disability and lost time at work. The spectrum of MSK diseases includes a wide range of ailments. They may involve a variety of anatomical components, including bone, structures within joints, and periarticular structures, which include muscles, tendons, ligaments, or bursae [1]. Measures like the International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO) can be used to assess the severity of a specific issue regardless of its root cause. The ICF comprises an evaluation of the body's structure and function as well as any restrictions on activity and involvement in everyday activities. Contextual factors, which can include individual and environmental factors, may have an impact on how any impairment manifests [2]. Diabetes mellitus (DM) is a chronic metabolic condition with a significant morbidity and mortality rate [3]. As the number of people with diabetes rises, the proportion of those who have functional disabilities will rise as well, creating a serious public health issue [4]. The most prevalent endocrine arthropathies are the musculoskeletal (MSK) consequences of diabetes mellitus (DM) [5]. Bangladesh is a developing nation with a disproportionately high prevalence of diabetes. Bangladesh is residence to more than one-third of all diabetics in the 48 least developed nations [6]. The musculoskeletal system may be impacted by diabetes mellitus (DM) in a variety of ways. Individuals with DM have been found to experience many rheumatologic problems more frequently than people without DM [7]. DM is associated with several musculoskeletal manifestations which are generally ignored and poorly treated as compared to other complications such as neuropathy, retinopathy and nephropathy. DM affects connective tissues in many ways and cause different alterations in periarticular and skeletal systems [8]. Patients with a lengthy history of type 1 diabetes are more likely to experience musculoskeletal issues, while type 2 diabetes patients might also experience them [9]. The body's balance depends on thyroid hormones (THs), which are essential. One of the main regulators of metabolism is the thyroid hormone, which modifies how much protein, carbohydrate, fat, and mineral the body uses [10]. Thyroid hormones are crucial for the growth, maturation, and preservation of the morpho-functional integrity of the musculoskeletal structures. Hormone deficit has negative effects on bone modeling and development, which have an impact on bone density and neuromuscular function. The mimicking of rheumatic diseases is undoubtedly one of the additional characteristics of the association between musculoskeletal impairment and thyroid disorders [11]. Thyroid gland pathology is currently regarded as one of the most prevalent endocrine illnesses in structure. Primary hypothyroidism is a significant endocrine disorder that affects several organs and is commonly accompanied by musculoskeletal dysfunction [12-14]. The aim of the study was to compare the musculoskeletal manifestations between diabetes and hypothyroidism patients.

2. Methodology

This cross-sectional study was carried out in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU) during January 2016 to December 2016. A total of 190 patients were participated in the study. Among them 95 were diabetic patients (Group-A) and 95 were patients with hypothyroidism (Group-B). Patients aged between 40-70 years both male and female, clinically diagnosed with diabetes and hypothyroidism for at least 5 years were included in the study. History/ evidence of infections, recent trauma, fracture, malignancy, tuberculosis severely ill patients and not willing to participate were excluded from the study. After taking consent and matching eligibility criteria, data were collected from patients on variables of interest using the predesigned structured questionnaire by interview, observation. Statistical analyses of the results were be obtained by using window based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-22), where required.

3. Results

Table 1 shows age distribution of the study population, it was observed that more than half (52.63%) patients were belonged to age 51-60 years in group A and half (50.58%) in group B. The mean age was 49.37 ± 12.03 in diabetes patients and 48.62 ± 11.13 years in hypothyroid patients.

Table 1: Age distribution of the study population.

Table 2 shows sex distribution of the study population, it was observed that majority (57.80%) patients were female in group A and 43(45.26%) in group B. The difference was not statistically significant (p>0.05) between two groups.

Table 2: Sex distribution of the study population.

Table 3 shows occupational status of the study population, it was observed that 23(24.21%) patients were house wives in group A and 24(25.26%) in group B. Followed by 23.16% retired in group A and 18.94% in group B and 20% service holder in group A and 52(54.74%) in group B. The difference was not statistically significant (p>0.05) between two groups.

Table 3: Occupational status of study population.

Table 4 shows socio-economic status of the study population, it was observed that almost two third (65.26%) of the patients come from middle class family in group A and 51(53.68%) in group B. The difference was not statistically significant (p>0.05) between two groups (Table 5).

Table 4: Socio-economic condition of study population.

Table 5: Height, weight and BMI of study population.

In Table 5 mean height was found 5.39 (±0.28) inches in group A and 5.31 (±0.34) inches in group-B. The mean weight was found 60.22(±8.83) kg in group A and 57.97(±8.02) kg in group-B. The mean BMI was found 25.2(±2.9) kg/m² in group A and 24.4(±3.2) kg/m² in group-B. The difference were not statistically significant (p>0.05) between two groups (Table 6).

Table 6: Common musculoskeletal disorders of study population.

Nineteen (20.0%) patients had osteoarthritis of knee in group A and 24(25.26%) in group B. Twelve (12.63%) patients had Adhesive capsulitis in group A and 5(5.26%) in group B. Nine (9.47%) patients had Flexor tenosynovitis in group A and 3(3.15%) in group B. Seven (7.37%) patients had Fibromyalgia in group A and 6(6.31%) in group B. Seven (7.37%) patients had Planter fascities in group A and 4(4.21%) in group B. DISH in group A 2(2.11%) and 1(1.05%) in Group B. Which were statistically significant (p<0.05) but other musculoskeletal disorders being not statistically significant (p>0.05) between two groups.

4. Discussion

This cross-sectional study was carried out in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka. During six month of study period, total 190 samples were included in this study, among them 95 patients were diabetics in group A and 95 were in hypothyroidism group B.

In this study it was observed that more than half (52.63%) patients were belonged to age 51-60 years in group A and half (50.58%) in group B. The mean age was 49.37 ± 12.03 in diabetes patients and 48.62±11.13 years in Hypothyroid patients. A previous study showed that mean age was found 48.87 ± 12.03 year in diabetes group [15]. A study showed the mean age of the study group was 46 ± 12 (20–76) years among them 7·3% (n = 10) had subclinical hypothyroidism [16]. Here, 57.80% patients were female in group A and 54.74% in group B. Barki et al. [17] showed that in diabetes mellitus, 158(42.1%) patients were males and 217(57.9%) were females [17]. A previous study titled Musculoskeletal manifestations in patients with thyroid disease; showed, 81% were female and 19% male [16].

In this current study mean height was found 5.39 (±0.28) inches in group A and 5.31 (±0.34) inches in group-B. The mean weight was found 60.22(±8.83) kg in group A and 88.0(±8.02) kg in group-B. The mean BMI was found 25.2(±2.9) kg/m2 in group A and 27.2(±3.2) kg/m² in group-B. The difference were not statistically significant (p>0.05) between two groups. Wang et al. [18] showed that, the mean BMI was found 24.79 ± 2.58 kg/m² in diabetes group [18]. Another study named Rheumatic manifestations in primary hypothyroidism; revealed that, mean body mass index (BMI) was 29.3 (±3.4) kg/m² which was a high BMI and not matched with our study [19]. In this study, 19(20.0%) patients had osteoarthritis of knee in group A and 24(25.26%) in group B. Similar observation was found in study of Nieves-Plaza et al. [20] in 2013 reported OA among diabetics patients was 49.0%. Kole et al. [19] showed osteoarthritis in 80 (66.7%) in hypothyroid patients [19]. Here, 12(12.63%) patients had Adhesive Capsulitis or Frozen Shoulder in group A and 5(5.26%) in group B. In study by Khan et al. [21] in 2008 reported 16.5% frozen shoulder in diabetes patients [21]. Schiefer et al. [22] showed, in the FS group, the prevalence of hypothyroidism diagnoses was significantly greater (27.2% vs. 10.7%; P =.001).

The study revealed that 5(5.26%) Rheumatoid arthritis was diagnosed in diabetes patients and 7(7.37%) was in hypothyroid patients. In study of Khan et al. [21] had similar observation they showed 20.1% Rheumatoid arthritis in diabetes group. Kole et al. [19] showed rheumatoid arthritis in 20 (16.67%) in hypothyroid patients. This study showed Fibromyalgia 7(7.37%) in diabetics and 6(6.31%) in hypothyroid patients. Tishler et al. [23] study showed Fibromyalgia was diagnosed in 17% with DM. Kole et al. [19] showed fibromyalgia in 6 (5%) in hypothyroid patients. The present study shows, 2(2.11%) DISH present in diabetes patients and 1(1.05%) in hypothyroid patients. If a person is obese, has a first-degree relative who has either HTS or DM, complains of lumbar or thoracic spinal pain, or has enthesopathies or tendonitis, they are more likely to have DISH in their fifth decade of life [24]. In the current study Flexor Tenosynovitis present 9(9.47%) in group A and 3(3.15%) in group B. SFTS has a reported prevalence ranging from 1.7% to 2.6% in the general population; however, the prevalence of SFTS in diabetic patients is reported to be between 10% and 20% [26-29]. A previous study found the prevalence of clinical CTS was 14% in diabetic subjects without DPN [30]. Another previous study shows, among 36 adult hypothyroid patients CTS were found in 6 (16.7%) patients [31]. In our study, 4(4.21%) patients had Carpel tunnel syndrome in group A and 6(6.31%) in group B. In all reviewed studies, Edema in the hands and feet is a symptom of hypothyroidism, including subclinical hypothyroidism in moderate forms. Plantar fasciitis may result from fluid collection around the nerves in the plantar fascia. Patients with diabetes, particularly those with type 2 diabetes, had prevalence rates of PF that were much greater than those in patients without diabetes. Increased BMI and female gender were also linked to increased prevalence of PF (Plantar fasciitis) [32]. However, this present study shows Plantar fasciitis were 7(7.37%) in diabetes patients and 4(4.21%) in hypothyroid patients. This study shows, Dupuytren's contracture 3(3.15%) in group A and 1(1.05%) were in group B. An incidence of 42% of symptoms of Dupuytren's disease was identified in adult diabetics participating in controlled clinical investigations. Older patients with a longer history of diabetes had the highest incidence [33].

5. Conclusion

Musculoskeletal conditions are persistent, incapacitating, and expensive. They have an impact on individuals of all ages, cultures, and ethnicities. For adults over the age of 18, these disorders are the primary cause of disability, loss of function, as well as restriction and impairment of activities [26]. Both Diabetes mellitus and hypothyroidism has been associated with a number of musculoskeletal manifestations. Identification and treatment of musculoskeletal manifestations are important to improve the patients’ quality of life.

Limitations of the study

The present study was conducted in a very short period due to time constraints and funding limitations. The small sample size was also a limitation of the present study.

Recommendation

This study can serve as a pilot to much larger research involving multiple centers that can provide a nationwide picture, validate regression models proposed in this study for future use and emphasize points to ensure better management and adherence.

Acknowledgements

The wide range of disciplines involved in comparison of musculoskeletal manifestations between diabetes and hypothyroidism patients research means that editors need much assistance from referees in the evaluation of papers submitted for publication. I would also like to be grateful to my colleagues and family who supported me and offered deep insight into the study.

Declaration

Funding:

None funding sources.

Conflict of interest:

None declared.

Ethical approval:

The study was approved by the ethical committee of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.

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