Endocrine Associated Arthropathies

Endocrine Associated Arthropathies 

1. Regional musculoskeletal complications can occur in 20% to 30% of patients with diabetes.

2. Frozen shoulder is a common and often overlooked diagnosis in patients with diabetes.

3. The diabetic stiff hand syndrome is related to disease duration and is associated with microvascular complications of the disease.

4. Hypothyroidism should be ruled out in a patient with muscle symptoms and an elevated creatine kinase (CK).

5. Carpal tunnel syndrome (CTS) can be the initial manifestation of hypothyroidism, diabetes mellitus (DM), and acromegaly.

6. Osteoporosis with fractures can be the initial presentation of hyperparathyroidism, Cushing’s disease, and hyperthyroidism.

Which endocrine diseases have well-described rheumatologic manifestations associated with them?

DM	Hyperparathyroidism
Hypothyroidism	Acromegaly
Hyperthyroidism	Cushing’s syndrome
Hypoparathyroidism	Hyperlipoproteinemia

Several endocrine disorders are associated with arthropathy (joint disease), either through direct hormonal effects or metabolic complications. These are referred to as endocrine arthropathies, and they can mimic or overlap with more common rheumatologic diseases.

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Endocrine-Associated Arthropathies

Here’s a breakdown by endocrine condition:

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1. Diabetes Mellitus

• Type of Arthropathy:
  • Charcot joint (neuropathic arthropathy) – often in the foot
  • Cheiroarthropathy – thick skin, limited joint mobility in hands (“prayer sign”)
  • Carpal tunnel syndrome
  • Dupuytren’s contracture
  • Frozen shoulder (adhesive capsulitis)
• Mechanism: Glycosylation of collagen, microvascular damage, and neuropathy

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2. Hyperparathyroidism

• Type of Arthropathy:
  • Pseudogout (calcium pyrophosphate deposition disease)
  • Subperiosteal bone resorption (especially in phalanges)
  • Bone pain or arthritis-like symptoms
• Mechanism: Increased calcium and phosphate metabolism → crystal deposition

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3. Hypoparathyroidism

• Type of Arthropathy:
  • Calcifications in joints and basal ganglia
  • Muscle cramps, stiffness, or spasms
• Mechanism: Low calcium levels → increased neuromuscular excitability

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4. Acromegaly

• Type of Arthropathy:
  • Large joint osteoarthritis-like symptoms
  • Hand and foot enlargement
  • Carpal tunnel syndrome
• Mechanism: Excess growth hormone → soft tissue overgrowth & cartilage hypertrophy

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5. Hypothyroidism

• Type of Arthropathy:
  • Myopathy, joint stiffness, and pain
  • Carpal tunnel syndrome
  • Non-inflammatory joint swelling
• Mechanism: Mucopolysaccharide deposition in tissues

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6. Hyperthyroidism (Graves’ disease)

• Type of Arthropathy:
  • Thyroid acropachy (clubbing, periostitis, swelling of hands/feet) – rare
  • Associated with autoimmune features
• Mechanism: Autoimmune cross-reactivity

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7. Cushing’s Syndrome

• Type of Arthropathy:
  • Osteoporosis and fractures
  • Myopathy and joint pain
• Mechanism: Cortisol-induced bone resorption, muscle wasting

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8. Menopause / Estrogen Deficiency

• Type of Arthropathy:
  • Osteoarthritis
  • Osteoporosis with associated joint/muscle pain
• Mechanism: Estrogen’s protective effect on bone and cartilage diminishes

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Summary Table:

Endocrine Disorder	Associated Joint/Soft Tissue Issues
Diabetes Mellitus	Charcot joint, cheiroarthropathy, frozen shoulder
Hyperparathyroidism	Pseudogout, bone resorption
Hypoparathyroidism	Joint calcifications, muscle cramps
Acromegaly	Large joint OA, carpal tunnel, soft tissue overgrowth
Hypothyroidism	Joint stiffness, carpal tunnel, myopathy
Hyperthyroidism	Thyroid acropachy
Cushing’s Syndrome	Osteoporosis, muscle/joint pain
Estrogen Deficiency	Osteoarthritis, osteoporosis