NITHIN CHAKRAVARTHY THESIS
THESIS
ARTHROPATHY IN TRUNCAL OBESITY PATIENTS AND ASSOCIATED COMORBIDITIES AND THIER OUTCOMES
NEED FOR STUDY AND INTRODUCTION:-
The association between OA and T2DM has been traditionally attributed to underlying shared risk factors of age and obesity. Emerging evidence suggests that alterations in lipid metabolism and hyperglycemia might have a direct impact on cartilage health and subchondral bone that contribute to the development and/or progression of OA.(ref 1)
While the above association is well studied and documented, patients with trunKal obesity and osteoarthritis are likely to have their illness outcomes considerably influenced by other comorbidities that are likely to affect their outcomes. This has not been studied earlier as per our review of literature and hence the need for this study
INTRODUCTION:-
There is increased susceptibility to develop arthritis in those with T2DM, which is supported by observations of higher prevalence of arthritis in those with T2DM (52%) compared to those without it (27%){2}. The association between OA and T2DM has been traditionally attributed to underlying shared risk factors of age and obesity. Emerging evidence suggests that alterations in lipid metabolism and hyperglycemia might have a direct impact on cartilage health and subchondral bone that contribute to the development and/or progression of OA. Adequate management of older persons with both OA and T2DM benefits from a comprehensive understanding[1]
It has been theorized that hypertension might affect OA via narrowing of blood vessels and subchondral ischemia, which would initiate cartilage degradation. several studies demonstrated higher prevalence of OA in individuals with hypertension{3,4}
AIM
Overall aim of this study is to evaluate the patients with diabetes mellitus having arthropathy in truncal obesity patients and knowing and establishing a correlation in onset of arthralgia and hypertension among them
OBJECTIVES:
To identify the spectrum of trunkal obesity and diabetic mellitus patients with arthropathy coming to general medicine
To study the clinical , radiological , and laboratory profile of the spectrum of diabetic mellitus people with arthropathy
To collect and document patient illness event data reflecting their morbidities and comorbidities in their individual historical timeline.
To match collected individual particular patient event data with past generalizable data around the "illness under study."
3)To evaluate each thematic category of ...study patient event data into diagnostically labeled morbidities as well as comorbidities and establish a relation between their intervention outcomes over time
4) To synthesise new learning outcomes over what is currently available and documented globally for patients with "trunkal obesity and arthropathy " and establish the relationship, if any, between the newly synthesized learning outcomes from each study patient participant and their or their subsequent study patient's healing outcomes.
To know the correlation between onset of hypertension and arthropathy in diabetic mellitus people
STUDY DESIGN
Observational study design
INCLUSION CRITERIA
1.Patients having two of the variables
a]Patients with diabetes mellitus and trucal obesity
b]Patients with arthropathy
2.Both men and females with diabetes mellitus
3.Both men and females with or with out hypertension
4.Written informed consent from each patient or legal guardian prior to enrollment
EXCLUSION CRITERIA
1.Patients having Rheumatoid arthritis
2.Patients having fluorosis
3.Patients having SLE and Psoriasis
4.Patients with arthropathy related to. coexisting autoimmune diseses
4.Patients not willing to give consent for study
METHOD OF DATA COLLECTION
Patients with abdominal girth(measured using measuring tape) above normal limits are selected
Their diabetic and hypertension status is evaluated
Their duration of illnesses are compared with duration of Arthropathy
Joints are evaluated clinically and radiologically
Xrays are used for knowing radiological status of joints
Hba1c is used to confirm diabetic status
Hypertension is evaluated with spygmomanometer and from anti hypertensive usage history
PATIENTS AND METHODOLOGY
PLACE OF STUDY :Department of General Medicine ,
KAMINENI INSTITUTE OF MEDICAL SCIENCES ,NARKETPALLY
STUDY PERIOD :2 YEARS(November 2023-October 2025)
STUDY DESIGN :Qualitative, Prospective and Observational study that evaluates each thematic category of patient illness event data into diagnostically labeled morbidities as well as comorbidities and establishes a relation between their intervention outcomes over time
SAMPLE SIZE : Proposed number of cases to be studied =50
CASE PROFORMA
Serial number
Name
Age
Sex
Occupation
OP/IP number
Education
Socioeconomic Status
Phone number
Residence
Complaints:
joint pains
polyuria
polyphagia
polydipsia
headache
Past history:
h/o diabetes mellitus since
h/o hypertension since
h/o chronic kidney diseases
h/o coronary artery diseases
h/o cerebrovascular accidents
h/o tuberculosis
h/o asthma
h/o retroviral diseases
h/o blood transfusions
Personal history
Alcohol history
Smoking history
Appetite
Bowel and Bladder habits
Family history
history of similar illness in family
General examination
Weight
Height
BMI
Pallor
Icterus
Lymphadenopathy
Clubbing
Cyanosis
Chest AP and Transverse Diameter
Elevated JVP
Facial puffiness
Pedal Edema
Abdominal girth
RESPIRATORY EXAMINATION:
Movements of chest:
Percussion:
Air entry:
Breath sounds:
CARDIOVASCULAR SYSTEM:
Heart sounds:
JVP:
Added sounds:
GASTROINTESTINAL SYSTEM:
Inspection: Palpation:
Shape of abdomen organomegaly
Umbilicus liver span
Percussion : Auscultation:
Shifting dullness Bowel sounds
CENTRAL NERVOUS EXAMINATION :
Higher mental functions:
Motor and sensory system:
Cerebellar functions:
Meningeal signs:
JOINT EXAMINATION
Inspection
Palpation
Local rise of temperature
Tenderness
crepitus
swelling
range of movements
INVESTIGATIONS :
CBP
LIPID PROFILE
FBS
PLBS
HBA1C
X RAY
OUTCOME:
Understanding of association of arthropathy in diabetes and hypertension helps us in adequate management of people with both arthropathy and T2DM and benefits from a comprehensive understanding of the risk factors associated with these disease emphasize the importance of physical activity to improve metabolism and decrease disability and pain in this population.[1}
CONSENT
I/WE, relative of the patient have read and understood the information provided in the patient information sheet and have been informed the purpose of the evaluation in the language I understand.
I am aware of the fact that I may not derive any benefit from the evaluation and that I deserve the right to opt out of the study at any point of time.
I willingly agree to participate in this study
Patients sign/thumb impression: witness sign/thumb impression
Name: name:
Date: date:
Residents sign:
Resident name:
date:
REFERENCES:
1}Sara R. Piva, PhD, PT, OCS, FAAOMPT,1 Allyn M. Susko, PT, DPT,1 Samannaaz S. Khoja, PT, MS,1 Deborah A. Josbeno, PhD, PT, NCS, CSCS,1 G. Kelley Fitzgerald, PhD, PT, FAPTA,1 and Frederico G. S. Toledo, MD2
2}Arthritis as a potential barrier to physical activity among adults with diabetes - United States, 2005 and 2007. MMWR Morb Mortal Wkly Rep. 2008;57(18):486–489. [PubMed] [Google Scholar]
3}. Zhuo Q, Yang W, Chen J, Wang Y. Metabolic syndrome meets osteoarthritis. Nature reviews. Rheumatology. 2012 Dec;8(12):729–737. [PubMed] [Google Scholar]
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