GANGGUAN MUSKULOSKELETAL PADA PENDERITA DIABETES MELITUS DI RSUP Dr. KARIADI SEMARANG

Abstract

Some musculoskeletal disorders (articular or extra-articular/soft-tissue rheumatism) are generally attributed to diabetes mellitus but there is not enough study to explore its. The objective of this study was to find out the frequency, clinical pattern of musculoskeletal disorders and to evaluate associations between musculoskeletal disorders the type with diabetic variables and microvascular complication. Material and Methode A cross sectional study was conducted on diabetic patients with rheumatic complaints in the Endocrinology and Rheumatology outpatient department of Dr. Kariadi Hospital Semarang, who met the inclusion and exclusion criteria.The study was carried out during July 1st 2001 to November 30st 2001. The patients were assessed for the presence of articular and extra-articular (soft tissue) rheumatism, diabetic variables such as ; age, duration of diabetes, glycemic control (HbAlc), duration of menopause, body mass index (BMI), lipid profile, serum uric acid, hypertension , smoking habit and microvascular complication; retinopathy background and proliferative, neuropathy and nephropathy. Data were analysed using Pearson's X2 test, Spearman correlation and binary logistic regression. Statistical significance was defined as p < 0.05. Results Seventy five persons (10.9%) of 684 diabetic patients had rheumatic complaints consisted of 49 (65%) female and 26 (35%) males . The highest frequency distribution age group was 60-69 years-old . Diabetic variables characterictics appeared in most patients consisted of ; < 5 years duration of diabetes, 33 (44%), good glycemic control 50 (68%), overweight 39 (52%), 11-20 years duration of menopause, 25 (71%), hypercholesterolemia 53 (71%). Most of cases (67 , 89%) had at least one microvascular complication. The highest prevalence of articular rheumatism was osteoarthritis of the knee 40 (53%) ; in extra-articular rheumatism was tendinitis of the shoulder 12 (16%).Twenty cases (27%) had grade II osteoarthritis of the knee and 66 (88%) cases had disability that caused musculoskeletal disorders. There were the association between the frequency of knee osteoarthritis with BMI CI=1.1-1.6) and diabetic retinopathy (p=0.007 CI=4.5-13.4). The severity of osteoarthritis of the knee was correlated with severity of diabetic retinopathy (p=0.017, r =0.278). Extra-articular rheumatism frequency was associated with glycemic control (HbAlc) , smoking habits and duration of menopause (p=0.037 CI=1.0-2.4, p=0.035 CI=1.2-46.0 and p=0.032 CI=1.0-1.2, respectively). Conclusions The frequency of musculoskeletal disorders in diabetes population in this study was 10.9%.The dominant frequency distribution of cases had characteristics ; female, overweight, 60-69 years age group, less than 5 years duration of diabetes , 11-20 years duration of menopause group, good glycemic control and hipercholesterolemia. The highest prevalence of musculoskeletal disorder was osteoarthritis of the knee. Most of cases had disability and at least one microvascular complication. There were the association between the frequency of knee osteoarthritis with BMI and diabetic retinopathy. The severity of osteoarthritis of the knee was correlated with severity of diabetic retinopathy. Extra-articular rheumatism frequency was associated with glycemic control (HbAlc) , smoking habits and duration of menopause Musculoskeletal disorder (osteoarthritis of the knee) was strongly suspected as chronic complication of diabetes and was associated with microvascular complication. Key words Musculoskeletal disorders, diabetes variables, microvascular complication Gangguan muskuloskeletal (reumatik) sering menyertai diabetes melitus (DM) meliputi reumatik artikuler dan reumatik ekstraartikuler. Belum banyak studi dilakukan untuk mengetahui keadaan tersebut. Penelitian ini bertujuan mengetahui frekuensi kejadian, pola klinis gangguan muskuloskeletal serta hubungan antara tipe/macam gangguan muskuloskeletal dan variabel-variabel diabetes dan komplikasi mikrovaskuler Bahan dan Cara : Populasi penelitian adalah penderita DM dengan keluhan reumatik di Poliklinik Endokrinologi dan Reumatologi RSUP Dr. Kariadi Semarang yang memenuhi kriteria penelitian. Penelitian dilakukan dengan pendekatan studi potong lintang periode 1 juli 2001 — 30 Nopember 2001. Penilaian penderita meliputi adanya kelainan reumatik artikuler dan ekstra-artikuler, karakteristik variabel-variabel diabetes yaitu : umur, lama diabetes, kontrol glikemik, lama menopause, indeks massa tubuh(IMT), profil lipid, asam urat darah, hipertensi, kebiasaan merokok, dan komplikasi mikrovaskuler; retinopati background/ proliferatif, neuropati dan nefropati. Data dianalisis dengan tes Chi Square, korelasi Spearman dan regresi logistik biner. Kemaknaan statistik menggunakan nilai p<0.05. Hasil : Dan 684 pasien DM didapatkan 75 (10.9%) penderita reumatik , 49 (65.3%) wanita dan 26 (34.7%) pria. Distribusi frekuensi kelompok umur terbanyak 60-69 th. Karakteristik variabel diabetes responden yang dominan meliputi; lama sakit DM < 5 th 33 (44%), kendali gula darah (HbAl c) kategori baik 50 (66.7%), IMT kategori kegemukan 39 (52%), lama menopause 11-20th 25 (70.7%), hiperkolesterolemia 53 (70.7%). Sebagian besar, 67 (89%) pasien sudah mempunyai salah satu komplikasi mikrovaskuler. Kelainan sendi terbanyak adalah Osteoartritis sendi lutut 40 (53.3%), kelainan reumatik ekstraartikuler terbanyak tendinitis sendi bahu 12 (16%). Dua puluh kasus (27%) menderita osteoartritis sendi lutut derajat II dan sebagian besar , 66 (88%) sudah memiliki disabilitas akibat gangguan muskuloskeletal. Terdapat hubungan yang bermakna antara osteoartritis sendi lutut pada penderita DM dengan IMT (p=3.007 CI=1.1-1.6) dan komplikasi retinopati DM (p=0.007 CI=1.5-13.4). Derajat berat OA sendi lutut berhubungan secara bermakna dengan derajat berat retinopati DM (p= 0.017 r = 0.278). Kelainan jaringan ikat (reumatik ekstraartikuler) pada penderita DM berhubungan secara bermakna dengan kendali gula darah (HbAl e), kebiasaan merokok dan lama menopause (p=0.037 CI= 1.0-2.4; p=0.035 CI= 1.2-46 ;p= 0.032 CI= 1.0-1.2). Kesimpulan : Frekuensi kejadian gangguan muskuloskeletal pada penderita DM pada studi ini adalah 10.9%. Distribusi frekuensi kasus yang dominan mempunyai karakteristik ; wanita, kegemukan, usia lanjut (6069 th), lama DM < 5 th, lama menopause 11-20 th, kontrol gula darah baik dan hiperkolesterolemia, Frekuensi terbanyak gangguan muskuloskeletal adalah osteoartritis sendi lutut. Sebagian besar kasus sudah memiliki disabilitas dan komplikasi mikrovaskuler. Terdapat hubungan secara bermakna antara osteoartritis sendi lutut pada penderita DM dengan IMT dan retinopati DM. Derajat berat OA sendi lutut berhubungan secara bermakna dengan derajat berat retinopati DM. Kelainan jaringan ikat pada penderita DM berhubungan secara bermakna dengan kendali gula darah (HbAlc), kebiasaan merokok dan lama menopause. Gangguan muskuloskeletal (OA lutut) patut diduga merupakan manifestasi komplikasi kronik DM yang sejalan / berhubungan dengan komplikasi mikrovaskuler. Kata kunci : Gangguan muskuloskeletal, variabel diabetes, komplikasi milcrovaskular