Stiff joints

[marylesko]

I have had type 1 diabetes for 38 years (I'm 48) with only eye complications (cataracts and minimal hemorrhaging - sight is 20/20 corrected).  However, over the past year, I've had pain / stiffness in my left shoulder, wrist, elbow, hip, knee, and ankle..and it's getting worse, impacting everything I do. The pain worsens only AFTER I've done a simple activity including walking down the hall, typing on the computer, or lying flat. I've seen a rheumatologist who has told me I have limited joint mobility (but I can put my fingers and palms together nicely which does not fit the criteria for LJM), and an orthopedic specialist who told me I have "arthrofibrosis" and that I shouldn't do anything that makes it more painful as that will worsen the fibrosis. All joint x-rays show no arthritis and all labs are completely normal (my HgbA1c is 6.8). My endocrinologist will not let me take an NSAID or coxib as he fears renal failure with use of these medications.

I cannot find anything dealing with arthrofibrosis and long-term diabetes.  Can someone help me find more information on what's going on and what I may be able to do to help myself?   Thank you.

[JDRF-VOL-RL]

Hello, Mary.  Congratulations on taking care of yourself so well for so long.  I'm not a medical professional, just the parent of a kid with diabetes.  The arthrofibrosis descriptions I've seen say that it's a complication of recent surgeries or injuries, but you don't mention that, only that it's after you do some simple activity.  What connection between your symptoms and that condition did the orthopedic specialist give you?

I can't find anything diabetes related for that condition, much less anything that talks about long term care, so I'm not sure I'm going to be any help.  I'd like to toss this out to everyone else to see if they have any ideas.

[marylesko]

Thanks for your input!  The arthrofibrosis, per the orthopedic consultant, is due to my long-term diabetes (due to collagen issues?).  He said "I see it all the time".  However, my research has resulted in the same outcome as yours...that arthrofibrosis can occur following trauma or surgery.  

I have had left hip surgery (impingement) and bilateral shoulder surgery (impingement in both), but remotely from the onset of symptoms (not to mention that the -fibrosis is also in joints without surgical intervention).  

[Larry68]

Joint issues related to connective tissues are common in diabetes. Examples are trigger finger (stenosing tenosynovitis) and frozen shoulder (adhesive capsulitis), both of which I have experienced after 40+ years as a type 1.  Here is some information on the conditions we are at risk for. http://clinical.diabetesjournals.org/cgi/content/full/19/3/132
Good BG levels now are positive, and have helped me mitigate my many complications, but even with the best control (and in our early years, the best available was poor by today’s standards) the elevated glucose levels do damage. It is my opinion that your orthopedist has classified you and dismissed you, without concern or real understanding for your underlying condition. There are treatments for these issues, and you need to find an orthopedist who is experienced in treating these complications related to diabetes. This may not be an easy task, but it is worth it.

[marylesko]

Thanks!  I will search the link you provided.  I am a rheumatology nurse practitioner and am familiar with numerous joint and connective tissue medical conditions.  However, my boss, a rheumatologist for > 40 years, has not seen the type of fibrosis I have. I have seen and treated trigger fingers as well as carpal tunnel, and other rheumatologic complications of diabetes (types 1 and 2), but no one in my hospital (a teaching hospital in the midwest) seems to know what's going on with my joints.  Hurry up and wait.  :)  Thanks again!

[JDRF-VOL-RL]

Thanks, Larry!  I've got another link to add to my information arsenal!