BANGLADESH JOURNAL OF RADIOLOGY AND IMAGING 2016; VOL. 24(1): 21-26 Evaluation of the X- ray Presentation of Osteoarthritis of Knee in Diabetic and Non Diabetic Subject SHARMISTHA DEY 1 , MAHBUBA HOSSAIN 2 , FAHMIDA YESHMINE 3 , TOWHIDUR RAHMAN 4 , AS MOHIUDDIN 5 Abstract patients. Conclusion: Osteophytes formation were Introduction: This cross-sectional study was statistically significant (p<0.05) between diabetic carried out in the Department of Radiology and and non-diabetic group. However, joint space Imaging of BIRDEM during 1st June 2014 to 30 th narrowing, sclerosis and subchondral cysts may 2015, to compare the difference between the formation were not statistically significant x-ray presentation of osteoarthritis of knee in (p>0.05). diabetic & non diabetic subjects. A total of 160 Introduction: patients clinically diagnosed as osteoarthritis of Osteoarthritis is a progressive, degenerative joint knee of diabetic and non diabetic subjects were disease characterized by chronic inflammation of enrolled in the study. Duration of pain in the joint lining. It is a joint disease that mostly osteoarthritic joint, Joint space narrowing, severity affects cartilage. Cartilage is the slippery tissue of osteophytosis, sclerosis and sub-chondral cyst that covers the ends of bones in a joint. Healthy formation was analyzed. Results: Joint space cartilage allows bones to glide over each other. It narrowing was absent in 04(3.6%), mild/moderate also helps absorb shock of movement. In in 69(62%) and severe in 37(33.6%) patients of osteoarthritis, the top layer of cartilage breaks diabetic group. Joint space narrowing was absent down and wears away. This allows bones under in 02(4%), mild/moderate in 30(60%) and severe the cartilage to rub together. The rubbing causes in 18(36%) patients of non-diabetic group. pain, swelling, and loss of motion of the joint. Over Osteophytes was absent in 20(18.2%), mild/ time, the joint may lose its normal shape. Also, moderate in 54(49.1%) and severe in 36(32.7%) bone spurs may grow on the edges of the joint. 1 patients of diabetic group. In non-diabetic group Among over 100 types of arthritis conditions, OA absence of osteophyte formation was not found, is the most common condition. In a study Haq et 22(44%) had mild/moderate and 28(56%) had al, it has been found that the prevalence of severe osteophyte formation in this group. Sclerosis osteoarthritis in Bangladesh is 7.5% in rural, 9.2% was absent in 42(38.2%), mild/moderate in in urban slum, 10.6% in urban affluent 52(47.3%) and severe in 16(14.5%) patients of community. 2 diabetic group. In non-diabetic group sclerosis was absent in18(36%), mild/moderate in 22(44%) and Osteoarthritis may be of two types — (a) Primary severe in 10(20%) patients. Subchondral cysts or idiopathic osteoarthritis and (b) Secondary formation was absent in 70(63.6%), mild/moderate osteoarthritis .Primary OA is mostly related to in 38(34.5%) and severe in 02(1.83%) patients of aging. With aging the water content of cartilage diabetic group. In non-diabetic group sub-chondral increases and protein made up of cartilage cyst formation was absent in 28(56%), mild/ degenerates. Secondary osteoarthritis may be moderate in 20(40%) and severe in 02(4%) of caused by various causes like- trauma, congenital 1.Assistant Professor, Department of Radiology & Imaging, BIRDEM 2. Junior Consultant, Department of Radiology & Imaging, BIRDEM. 3. Associate Professor, Department of Radiology & Imaging, BIRDEM 4. Assistant Professor, Department of Radiology & Imaging, BIRDEM and 5. Professor & Head, Department of Radiology and Imaging, BIRDEM, Dhaka.
Bangladesh Journal of Radiology and Imaging Vol. 24(1): January 2016 to investigate the difference between x-ray cause, metabolic, endocrine, gout and pseudogout, presentations of osteoarthritis of knee in diabetic neuropathic (charcot joint). 3 Among the endocrine and non-diabetic subjects causes Diabetes mellitus, growth hormonal disorders are also associated with early cartilage Materials & Methods: wear and secondary OA 4 . Although the Cardinal This cross sectional study was performed in the pathological feature of osteoarthritis is a Department of Radiology and Imaging, BIRDEM progressive loss of articular cartilage, from June 2014 to May 2015, who were referred osteoarthritis is not disease of only the cartilage from medicine out patients Department, BIRDEM, but a disease of an organ, the synovial joint, in for plain x-ray both knee joints AP view. 200 which all of tissue are affected. The most patients were collected consecutively, out of them morphological changes in osteoarthritis are 15 having decreased bone density, 10 having H/0 trauma, 10 having neuropathic joint and another usually seen in load bearing areas of the articular 5 with deformity of the joints were excluded from cartilage. Remodeling and hypertrophy of bone are the study. Ultimately a total of 160 patients were major features of osteoarthritis, appositional bone included in this study. Out of them 110 were growth in the subchondrial region, leading to the diabetic and 50 were non diabetic. bone ‘sclerosis’ seen radiographically. Growth of The objective of the study was to find out the bone at the joint margins leads to osteophytes difference between the x-ray presentation of (spur) which alter the contour of the joint and may osteoarthritis of knee in diabetic & non diabetic restrict movement. Periarticular muscle wasting subjects. Demographic information was is common and may play a major role in symptoms prospectively recorded and substantiated by and as indicated above, in disability. 5 means of inspection of medical record. Information Diabetes Mellitus is a metabolic disorder the included the subject’s age, sex, followed by plain prevalence of which is increasing day by day x-ray knee joint AP view. throughout the world. It can be noted that 95% The x-ray both knee joint AP view was performed diabetic subjects have type 2 disease. In 2000, by an efficient technician under observation of the Bangladesh had 3.2 million people with Diabetes investigator herself. For evaluation the mellitus and was listed at 10, which will occupy investigator herself and two radiologists did the 7th position with 11.1 million in 2030. As interpretation of the films without knowing the estimated on the basis of present prevalence rates two groups (diabetic and non-diabetic) to get of diabetes (Type-2-5.2% and IGT-12.5%), in the unbiased reports. projected population more then 10 million Observation and Results: Bangladeshi will suffer from the disease on the The study was conducted in the department of year 2010. 6 radiology and imaging at BIRDEM from June 2014 suggested that prevalence of OA is higher in young to May 2015. The main objective of the study was and middle aged diabetic subjects than in non- to find out the comparison between x-ray diabetic subjects. 7 presentation of osteoarthritis of knee in diabetic and non-diabetic subjects. A total of 160 subjects Insulin has been demonstrated to stimulate were included in the study. All the subjects cartilage growth and proteoglycan biosynthesis. underwent X-ray of both knee joints AP view. The These effects are likely to be mediated through findings derived from the data analysis are somatostatin (Insulin like growth factor-I) (Husni furnished below. et al., 2007).7 It is suggested that the diminished availability of insulin at the cellular level or The study included 160 patients with diabetic micro-vascular disease attenuates the osteoarthritis were divided into three groups chondro and osteogenesis required for osteophyte according to their duration of osteoarthritis (OA), formation in the joints of patients with which were <5 years, 6-10 years and >10 years. osteoarthritis. 8 Since insulin is a potent growth The severity of osteophytosis and subchondral sclerosis was analyzed in relation to the duration factor for connective tissue, the study is designed 22
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