Peripheral vascular disease Diabetes accelerates hardening of the arteries (atherosclerosis). The vessels that supply the legs can become so narrowed that they do not carry enough blood. If this happens it can cause pain when the person walks or exercises. This type of pain is called intermittent claudication because the symptoms are intermittent and get better with rest but recur after exercise. Intermittent claudication is caused by a blood vessel problem and is not a type of arthritis. Because it causes pain in the legs while walking, patients can be incorrectly diagnosed and treated for arthritis.
Hand contractures Patients who have had diabetes for many years can develop fibrous tissue in the tendons of their fingers so that they cannot straighten them completely. This is called diabetic cheirarthropathy or diabetic contracture. It causes clumsiness and tightness of the fingers, and other than good control of the blood sugar, there is no effective treatment for it. Diabetes increases the chances of developing dupuytren's contracture and can also cause tight skin on the fingers. An increase in the fibrous tissue of the finger tendons can cause them to catch and then suddenly release when an affected finger is flexed, called trigger finger.
Shoulder tendinitis Patients with diabetes have an increased chance of developing shoulder tendinitis that causes pain in the shoulder when lifting the arm and can lead to a frozen shoulder.
Neuropathic arthritis Diabetes can damage the nerves in the feet and legs so that the person cannot feel exactly where his or her ankles and feet are, and the individual walks awkwardly. The person does not feel that the ankle or foot joints are being damaged (see neuropathic arthritis).
Diabetic nerve and muscle damage Damage to nerves of the hands and feet (peripheral neuropathy) can cause numbness, tingling, and pain in the glove and stocking areas. it can also affect muscles so that they shrink (atrophy) and become weak.
Other conditions diffuse idiopathic skeletal HYPEROSTOSIS (DISH), CARPAL TUNNEL SYNDROME, and infections of bone (osteomyelitis) and joints (infective arthritis) are more common in patients with diabetes.
dialysis A process used to filter waste products and toxins out of blood and replace the function of the kidneys. There are two common types of dialysis, hemodialysis and peritoneal dialysis. With hemodialysis blood is removed from a patient, filtered through a membrane in a machine, and then returned. Peritoneal dialysis removes waste products from the bloodstream by running clear fluid into a space in the abdomen called the peritoneal cavity and then later removing the fluid after waste products have passed into it. Patients who have been on dialysis for a long time have a greater chance of developing some arthritis problems.
One of the commonest rheumatic problems is pain in the bones caused by increased activity of the parathyroid glands. This is called secondary hyperparathyroidism and is a natural response to the low calcium and high phosphate levels found in the blood of patients with poor kidney function. secondary hyperparathyroidism is treated with a low-phosphate diet and drugs such as calcium salts that lower the concentrations of phosphate by binding it in the gut and preventing it from being absorbed into the body.
Patients who have been on hemodialysis for a long time have an increased chance of developing arthritis caused by the accumulation of a protein, beta2-microglobulin, that is not removed from the bloodstream by hemodialysis. This substance, a type of amyloid, can collect in the carpal tunnel, causing carpal tunnel syndrome, and in the synovial cavity causing arthritis. The diagnosis of this type of arthritis is usually suspected when a patient who has been on hemodialysis for many years develops arthritis, most often affecting the shoulders, wrists, hips, and small joints of the hands. The X rays show cysts that have occurred because small pieces of bone have been eroded. some experts believe that the accumulation of beta2-microglobulin by itself is not the entire cause and that secondary hyperparathyroidism, bone problems resulting from aluminum accumulation and deposits of hydroxyapatite crystals, may also contribute. There is no specific treatment for this type of arthritis. However, it can be improved if a patient who has been on dialysis receives a renal transplant and can discontinue dialysis.
The kidneys excrete uric acid in the urine so that poor kidney function causes uric acid levels in the blood to rise and increases that chance that crystals will accumulate in the joints and cause an attack of acute gout.
diet Many people believe that diet affects their arthritis or that dietary supplements or vitamins improve their symptoms. A lot has been published about the effects of diet on arthritis. Other than the fact that uric acid levels are elevated in people who drink large amounts of alcohol or eat a lot of red meat or organ meats (see gout), the results have not been consistent. Many of the studies have been uncontrolled and open label (see clinical trial), and their results may therefore be biased toward showing a positive effect.
several studies have shown that total fasting improves the symptoms of rheumatoid arthritis (RA) in some patients, but the effects are temporary. Because it was possible that food allergy aggravated arthritis, researchers have studied the effects of elemental and exclusion diets. Elemental diets contain minerals and amino acids rather than complex proteins and have resulted in a modest improvement in symptoms in some patients but are impractical. Exclusion diets eliminate certain food types and have identified a few patients whose arthritis is consistently worsened by a certain food type, for example milk products. These patients appear to benefit by avoiding certain food types, but overall, exclusion diets have not been successful in patients with arthritis.
Several studies have found that a vegan or vegetarian diet resulted in a modest improvement in RA, but the scientific evidence is not strong enough to recommend this as a useful component of routine treatment. Many dietary supplements such as yeast, cider vinegar, honey, copper, zinc, magnesium, garlic, ginger, alfalfa, and shark cartilage have been used to treat arthritis without adequate evidence available to support or refute claims for their efficacy. oxidative stress resulting in increased production of free radicals appears to be increased in many types of arthritis. Antioxidant vitamins, particularly vitamin E and vitamin C, have therefore been suggested as treatments for arthritis. in some studies, high doses of vitamin E improved the symptoms of RA. Vitamin C did not appear to improve symptoms of RA or osteoarthritis (OA) but was associated with a slower progression of OA in one study.
Some unsaturated fatty acids, particularly those found in fatty fish such as cod and in some plants such as evening primrose oil, decrease the production of inflammatory prostaglandins. Many studies have examined the effects of fish oil and evening primrose oil in arthritis, and some have found modest benefits in RA.
Overall, there are not enough high-quality studies of the effects of dietary supplements in arthritis to be certain of their effects. Most experts recommend a healthy balanced diet without any specific exclusions or supplements for patients with arthritis. if patients do become aware of a foodstuff that appears to make their arthritis worse, it is best to consult a dietician to design an exclusion diet to test whether their impression is really true. The dietician can then advise them on healthy eating with the exclusion of an implicated food. processed food today is so complex it can be very difficult for the individual to do this.
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