DIABETIC WITH AN UNUSUAL JOINT COMPLICATION

Ram Singh, Ashish Bhalla, S.S. Leal, Atul Sachdec, Deptt, of Medicine, Govt. Medical College Hospital, Chandigarh.

Neuropathic joints are seen in various disorders.  They are uncommon complication of diabetes these days.  We report on such case.

55 yrs old female presented with progressively increasing breathlessness of three days duration associated with orthopnea, and paroxysmal nocturnal dyspnea and inability to stand for one year.  Patient was a case of diabetes and hypertension for previous ten years on regular treatment.  Examination revealed pallor, pitting oedema, elkevat JVP, foot deformity (Charcot Joints).  Tachycardia with third heart sound, bilateral basal creps and hepatomegaly were present.  Neurological examination was normal except loss of joint position and vibration sense on lower limbs.  Fundus showed proliferative retinopathy.  On investigations she had microcytic hypochromic anemia, elevated urea and creatinine with nephritic range proteinuria.  Cardiamegaly on Chest X-ray and old anteroseptal myocardial infarction, on ECG were present.  Patient was stabilized with diuretics, nitroglycerine, disprin, amlodipine, iron supplements, insulin and antibiotics.  Before discharge orthopedic opinion was taken.  Diagnoscs of Charcot joints was confirmed clinically and radiologically, Patient was advised shoes and physiotherapy.

Diabetes is the leading cause of neuroarthopathic joints.  Incidence varies from 0.8 to 7.5%.  Bilateral involvement is seen in 5.9% to 39.3% cases, with very high incidence of fracture of ankle and tarsal bones Management involves 3 months of no weight bearing cast immobilization before resumption of partial weight bearing in therapeutic shoe or walking brace.  Surgical management requires arthrodesis with variable success.

EFFECT OF AEROBIC EXERCISE IN NON-INSULIN DEPENDENT  DIABETES MELLITUS (NIDDM)