Knee osteoarthritis in type 2 diabetes mellitus: does insulin therapy retard osteophyte formation?

Objective: The aim of this study was to investigate whether or not radiographic changes observed in knee osteoarthritis [OA] in type 2 diabetes mellitus [T2DM] patients on insulin therapy differed from those not on insulin

Material and Methods: A cross-sectional study was performed in 311 subjects: 211 T2DM patients and 100 without diabetes [controls] in Mubarak Hospital, Kuwait. Patients were categorized into 3 groups: T2DM patients not on insulin [G1, n = 99], T2DM patients on insulin [G2, n = 112] and a nondiabetic control group [G3, n = 100]. Plain X-ray of both knees was used to assess the changes of knee OA and graded using the Kellegren-Lawrence scale [0-4] and the Osteoarthritis Research Society International Atlas grading scale [0-3]. A total of 622 knee X-rays were evaluated. SPSS version 21.0 was used for data analysis

Results: A highly significant association [p < 0.0001] was observed for joint space narrowing [JSN] as well as for osteophyte formation between the three groups. Comparing G2 and G3, a highly significant association [p < 0.0001] was retained for JSN [201 [89.7%] vs. 199 [99.5%]] and for osteophyte formation [26 [11.7%] vs. 72 [36.0%]]. Comparing G1 and G2, significantly less osteophyte formation was noted in G2 patients compared to G1 patients [26 [11.7%] vs. 39 [19.7%], p = 0.02]. Multivariate logistic regression analysis showed that the G2 group had less chance of osteophyte formation than either the G1 group or G3 control group [OR = 0.294, p = 0.008 and OR = 0.098, p < 0.001, respectively]

Conclusion: Our findings show that T2DM patients with OA knees on insulin therapy have less radiographic osteophytes compared to T2DM patients not on insulin

Prospective evaluation of the effect of short-term oral vitamin D supplementation on peripheral neuropathy in type 2 diabetes mellitus

We aimed to assess the efficacy of short-term oral vitamin D supplementation on peripheral neuropathy in patients with type 2 diabetes. Materials and This prospective, placebo-controlled trial included 112 type 2 diabetic patients with diabetic peripheral neuropathy [DPN] and vitamin D [25[OH]D] deficiency. Patients were sequentially assigned to a treatment group [n = 57] and a placebo group [n = 55]. DPN was assessed using a neuropathy symptom score [NSS], a neuropathy disability score [NDS] and a nerve conduction study [NCS]. Vitamin D status was determined by measuring the serum total 25[OH]D concentration. Patients received either oral vitamin D[3] capsules or starch capsules once weekly for 8 weeks. The primary outcome was changes in NSS and NDS from baseline. The secondary outcome was changes in the NCS result. Serum 25[OH]D concentrations significantly improved after oral vitamin D supplementation in the treatment group when compared to the placebo group [32.8 +/- 23.7 vs. 1.1 +/- 3.6, p < 0.0001]. Similarly, the improvement in NSS values was significantly greater in the treatment group than in the placebo group [-1.49 +/- 1.37 vs. -0.20 +/- 0.59, p < 0.001]. No improvement was observed for NDS and NCS between the 2 groups after treatment. Short-term oral vitamin D[3] supplementation improved vitamin D status and the symptoms of neuropathy in patients with type 2 diabetes

Magnetic Resonance Imaging of the Lumbar Spine in Young Arabs with Low Back Pain

STUDY DESIGN: A prospective study. PURPOSE: To Investigate the prevalence of magnetic resonance imaging (MRI) changes of the lumbar spine in low back pain (LBP) and the associated risk factors in young Arab population. OVERVIEW OF LITERATURE: Studies on the prevalence of MRI findings and their relationship with LBP have been conducted; these have occurred in adult populations in developed countries. The prevalence of MRI changes in the young Arab population with LBP is not known. METHODS: Two hundred and fourteen patients of Arab origin in the 16 to 29 year age group with LBP symptoms underwent MRI examinations. The prevalence of MRI changes in the lumbar spine and associated risk factors were determined and compared to age, race, and gender-matched controls. RESULTS: A majority (64%) of the patients with LBP (138 out of 214) were found to have MRI evidence of degenerative disc disease (DD) compared to 10% (22 out of 214) in the control group. The majority (61%) of patients had multiple level disease, most commonly involving the lowest 2 disc levels. Reduced signal of the disc followed by disc bulge was the most common MRI features seen in the symptomatic subjects. Obesity correlated with MRI prevalence of abnormalities, while activity demonstrated a positive trend. CONCLUSIONS: The MRI prevalence of DD among the young Arab patients with LBP is high when compared to other reports in literature. Obesity correlated with MRI prevalence of abnormalities while activity demonstrated a positive trend.

Ossification of ligamentum flavum in middle east Arabs: a hospital-based study

To investigate the frequency of ossification of the ligamentum flavum [OLF] in the spine among the Arab population in Kuwait using magnetic resonance imaging [MRI] surveillance of the whole spine. A consecutive series of 102 patients with low back pain were recruited from the outpatient clinic of Mubarak Al-Kabeer Hospital, Kuwait. MRI of the whole spine in the sagittal plane was obtained in at least two sequences [T[1] and T[2]]. The OLF was defined as low signal intensity thickening of the ligament in both T[1] and T[2] sequences on the posterior margin of the spinal canal, causing indentation of the theca with or without cord compression. Of the 102 cases, 19 [18.6%] patients had OLF. Of the 19 positive cases, 12 [63.2%] were present at a single level, and 7 [36.8%] at multiple levels. A total of 26 OLF segments were identified in the following anatomical distribution: cervical: 15 [57.7%]; upper thoracic [T1-T4]: 1 [3.8%]; mid thoracic [T5-T8]: 4 [15.4%]; lower thoracic [T9-T12]: 4 [15.4%], and lumbar region: 2 [7.7%]. Of the 19 OLF patients, 2 [10.5%] had tandem ossification of the posterior longitudinal ligament in the cervical spine and were symptomatic. The frequency of OLF appears to be high among this hospital-based cohort of the Arab population. OLF should be kept in mind if a patient presents with radiculopathy, particularly in the cervical region, for which surgical intervention is contemplated

Is low back pain prevalent among Kuwaiti children and adolescents?

To measure the magnitude of the problem of low-back pain among 10- to 18-year-old Kuwaiti schoolchildren in Hawalli Governorate. Subjects and A cross-sectional multistage stratified random sample of 400 schoolchildren [199 males and 201 females] of ages 10-18 years were selected from two junior and two high schools in Hawalli Governorate, Kuwait. Data on age, gender and characteristics of low-back pain such as duration, location and frequency were collected through personal interviews using a questionnaire. Low-back pain was defined as pain in the back from the 12th rib to the buttock area. According to our definition, reported lifetime prevalence of low-back pain was found to be 57.8% [50.8% in male and 64.7% in female students], while the point prevalence was 35% [20.6% in male and 39.3% in female students]. More female students reported low-back pain than male students, and the prevalence of low-back pain was found to increase with age in both sexes. The age of onset of low-back pain was 14 years in males and 13 years in females. The majority of students [92.1% in males, 84.6% in females] reported pain in the low back. Almost 46% of students related their low-back pain to accidents. A significantly higher proportion of male students [58.4%, compared to females 36.2%] reported low-back pain caused by accident or with duration of recovery less than a week [21.8% for males as compared to 16.2% for female students]. Female students reported more recurrent or continual low-back pain. Low-back pain is common among Kuwaiti students in Hawalli Governorate. Prevalence of low-back pain increased with age in both sexes. Female students reported more frequent low-back pain than male students