Dados do Trabalho

Title

GENDER DIFFERENCES IN THE EFFECT OF DIABETES MELLITUS AND ITS TREATMENT ON OSTEOARTHRITIC PAIN

Background

There is increasing evidence on the association between type 2 Diabetes Mellitus (DM) and osteoarthritis (OA). Subjects with diabetes are nearly twice as likely to have OA and arthroplasty than subjects without diabetes, independent of age or BMI. It has been suggested that subjects with both, DM and OA, have more severe symptoms. In addition, DM and insulin resistance have been considered as predictors of joint space narrowing and knee osteoarthritis (KOA) only in males. This difference that concerns male gender, DM and OA especially regarding pain symptoms has not been fully investigated. Our objectives are: 1) To investigate differences in pain severity and its distribution between patients with and without diabetes mellitus (DM) in a population with advanced osteoarthritis (OA). 2) To explore the role of medication used for diabetes in these associations.

Materials and methods

This is a Hospital based-cohort study of patients with advanced OA requiring total joint arthroplasty (TJA). Interviews and electronical records included: age, gender, occupation, DM (including medication and duration), analgesics used, anthropometry, joints affected by pain and disease duration. Joint pain was scored by the patients using numerical rating scale (NRS). Pain severity score was calculated adding the number of joints affected by pain and the maximum pain score. Analysis of Variance (ANOVA) was used to compare between two groups. Logistic regression was used to analyze association between joints affected and DM. Chi-square and Fisher’s exact tests were used to compare variables.

Results

In total, 489 patients with painful OA were included. From them, 139 patients had DM (30% males). Pain severity and analgesic consumption was higher in males with diabetes compared with males without diabetes (12% difference, P= 0.01 and OR=3.03; CI:1.24-7.36, P=0.015, respectively). These associations were not significant in females (P=0.41 and P= 0.60). Pain was more severe in males with DM using insulin than in those with diabetes using any other treatments or without treatment (Fig.1, P=0.025). Male subjects with diabetes had higher odds of hand pain or knee and hand pain compared with males without diabetes (OR=3.7, CI=1.15-12; P=0.028 & OR=5.54; CI=1.43-21.5, P=0.013).

Conclusions

Men with diabetes, especially those who require insulin, have more severe joint pain and consume more analgesics than men without diabetes or those who have DM and use other DM-medication. Differences in pain between males with and without diabetes might point to the effect of the severity of DM on chronic OA-pain.