6/20/2019
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`Bone and joint problems associated with diabetes - Mayo Clinic
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`MAYO
`CLINT
`
`~
`
`Bone and joint problems associated with
`diabetes
`
`By Mayo Clinic Staff
`
`If you have diabetes, you're at increased risk of various bone and joint disorders. Certain factors,
`such as nerve damage (diabetic neuropathy), arterial disease and obesity, may contribute to these
`problems - but often the cause isn't clear.
`
`Learn more about various bone and joint disorders, including symptoms and treatment options.
`
`What is it?
`
`Charcot (shahr-KOH) joint, also called neuropathic arthropathy, occurs when a joint deteriorates
`because of nerve damage - a common complication of diabetes. Charcot joint primarily affects
`the feet.
`
`What are the symptoms?
`
`You might have numbness and tingling or loss of sensation in the affected joints. They may
`become warm, red and swollen and become unstable or deformed. The involved joint may not be
`very painful despite its appearance.
`
`How is it treated?
`
`If detected early, progression of the disease can be slowed. Limiting weight-bearing activities and
`use of orthotic supports to the affected joint and surrounding structures can help.
`
`What is it?
`
`Diabetic hand syndrome, also called diabetic cheiroarthropathy, is a disorder in which the skin on
`the hands becomes waxy and thickened. Eventually finger movement is limited. What causes
`diabetic hand syndrome isn't known. It's most common in people who've had diabetes for a long
`time.
`
`What are the symptoms?
`
`You may be unable to fully extend your fingers or press your palms together flat.
`
`How is it treated?
`
`https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes/art-20049314?p=1
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`6/20/2019
`Bone and joint problems associated with diabetes - Mayo Clinic
`Better management of blood glucose levels and physical therapy can slow the progress of this
`condition, but the limited mobility may not be reversible.
`
`What is it?
`
`Osteoporosis is a disorder that causes bones to become weak and prone to fracture. People who
`have type 1 diabetes have an increased risk of osteoporosis.
`
`What are the symptoms?
`
`Osteoporosis rarely causes symptoms in the early stages. Eventually, when the disease is more
`advanced, you may experience loss of height, stooped posture or bone fractures.
`
`How is it treated?
`
`A healthy lifestyle, including weight-bearing exercise, such as walking, and eating a balanced diet
`rich in calcium and vitamin D -
`including supplements if needed - are the best ways to address
`this condition. In some patients with more severe or advanced disease, medications to prevent
`further bone loss or increase bone mass may be needed.
`
`What is it?
`
`Osteoarthritis is a joint disorder characterized by the breakdown of joint cartilage. It may affect any
`joint in your body. People who have type 2 diabetes have an increased risk of osteoarthritis, likely
`due to obesity - a risk factor for type 2 diabetes -
`rather than to the diabetes itself.
`
`What are the symptoms?
`
`Osteoarthritis may cause joint pain, swelling and stiffness, as well as loss of joint flexibility or
`movement.
`
`How is it treated?
`
`Treatment involves exercising and maintaining a healthy weight, caring for and resting the affected
`joint, physical therapy, medications for pain, and surgery such as knee or hip replacement Uoint
`arthroplasty). Complementary treatments -
`such as acupuncture and massage - also may be
`helpful for managing pain.
`
`What is it?
`
`Diffuse idiopathic skeletal hyperostosis (DISH), also called Forestier disease, is a hardening of
`tendons and ligaments that commonly affects the spine. DISH may be associated with type 2
`diabetes, perhaps due to insulin or insulin-like growth factors that promote new bone growth.
`
`What are the symptoms?
`
`You may experience pain, stiffness or decreased range of motion in any affected part of your body.
`If DISH affects your spine, you may experience stiffness in your back or neck.
`
`How is it treated?
`
`Treatment involves managing symptoms, usually with pain relievers (Tylenol, others), and in rare
`cases may require surgery to remove bone that has grown due to the condition.
`
`https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes/art-20049314?p=1
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`6/20/2019
`What is it?
`
`Bone and joint problems associated with diabetes - Mayo Clinic
`
`Dupuytren's contracture is a deformity in which one or more fingers are bent toward the palm. It's
`caused by thickening and scarring of connective tissue in the palm of the hand and in the fingers.
`Dupuytren's contracture is common in people who've had diabetes for a long time, perhaps due to
`the metabolic changes related to diabetes.
`
`What are the symptoms?
`
`You may notice thickening of the skin on the palm of your hand. Eventually, you may not be able to
`fully straighten one or more fingers.
`
`How is it treated?
`
`If you have pain, a steroid injection may help by reducing inflammation. Surgery, collagenase
`enzyme injection and a minimally invasive technique called aponeurotomy to break apart the thick
`tissue are other options if the condition prevents you from being able to grasp objects.
`
`What is it?
`
`Frozen shoulder is a condition characterized by shoulder pain and limited range of motion. It
`typically affects only one shoulder. Although the cause is often unknown, diabetes is a common
`risk factor.
`
`What are the symptoms?
`
`Frozen shoulder causes pain or tenderness with shoulder movement, stiffness of the joint, and
`decreased range of motion.
`
`How is it treated?
`
`If started early, aggressive physical therapy can help preserve movement and range of motion in
`the joint.
`
`1. Additional types of neuropathy. American Diabetes Association. http://www.diabetes.org/living-with(cid:173)
`
`diabetes/complications/neuropathy/additional-types-of-neuropathy.html. Accessed Dec. 5, 2016.
`
`2. Leslie WD, et al. Diabetes and bone disease. In: Endocrinology and Metabolism Clinics. Philadelphia, Pa.: Saunders
`
`Elsevier; 2016. http://www.clinicalkey.com. Accessed Dec. 5, 2016.
`
`3. Epstein S, et al. Diabetes and disordered bone metabolism (diabetic osteodystrophy): Time for recognition.
`
`Osteoporosis International. 2016;27: 1931.
`
`4. Hull B, et al. Diabetes and bone. The American Journal of the Medical Sciences. 2016;351 :356.
`
`5. What people with diabetes need to know about osteoporosis. National Institute of Arthritis and Musculoskeletal and
`
`Skin Diseases. http://www.niams.nih.gov/Health _Info/Bone/Osteoporosis/Conditions_ Behaviors/diabetes.asp.
`
`Accessed Dec. 5, 2016.
`
`6. Osteoporosis overview. National Institute of Arthritis and Musculoskeletal and Skin Diseases.
`
`https://www.niams.nih.gov/Health_lnfo/Bone/Osteoporosis/overview.asp. Accessed Dec. 5, 2016.
`
`7. Dupuytren's contracture. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?
`
`topic=A00008. Accessed Dec. 5, 2016.
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`Sanofi Exhibit 2182.003
`Mylan v. Sanofi
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`Bone and joint problems associated with diabetes - Mayo Clinic
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`8. Handout on health: Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases.
`
`http://www.niams.nih.gov/Health_lnfo/Osteoarthritis/default.asp. Accessed Dec. 5, 2016.
`
`9. Imboden JB, et al. Endocrine and metabolic disorders. In: Current Diagnosis & Treatment: Rheumatology. 3rd ed. New
`York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com. Accessed Dec. 5, 2016.
`
`10. Aggarwal R, et al. Dupuytren's contracture. http://www.uptodate.com/home. Accessed Dec. 5, 2016.
`
`11. Hordon LD. Limited joint mobility in diabetes mellitus. http://www.uptodate.com/home. Accessed Dec. 5, 2016.
`
`12. Prestgaard TA. Frozen shoulder (adhesive capsulitis). http://www.uptodate.com/home. Accessed Dec. 5, 2016.
`
`March 09, 2017
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`Orig in al article: https ://www.mayoclinic.org/d iseases-conditions/d iabetes/in-depth/d iabetes/art-20049314
`
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`Sanofi Exhibit 2182.004
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