Background/Purpose: Knee osteoarthritis (OA) and type 2 diabetes commonly co-occur due to shared risk factors. Concomitant knee OA makes type 2 diabetes management, particularly engaging in physical activity, challenging and has been associated with increased risk for diabetes complications. The extent to which OA is diagnosed and managed in individuals with type 2 diabetes, however, is unclear, and could be limited by the competing demands of diabetes. We sought to assess: 1) the prevalence of symptomatic knee OA (fulfilling NICE clinical criteria) in persons with type 2 diabetes, including the proportion who had received a physician diagnosis; and 2) the extent to which OA therapies had been used.

Methods: This was a descriptive cross-sectional study of individuals with type 2 diabetes ≥45 years old followed in outpatient endocrinology clinics at three academic hospitals in Toronto, Canada. Participants completed standardized online questionnaires. We assessed, on a homunculus, joint areas that were troublesome (painful, aching, swollen, and/or stiff) for most days over the last 3 months. We defined knee OA as fulfilling NICE UK criteria: activity-exacerbated knee pain, morning joint stiffness ≤30 min, and no history of inflammatory rheumatic disease. Participants were asked to indicate if they had consulted a health care provider, received a diagnosis, and any treatments used (yes/no, from list) for their joint symptoms. We calculated the prevalence of chronic lower extremity joint symptoms and symptomatic knee OA. Of those with symptomatic knee OA, we calculated the proportion who had sought care from a health care provider, received a diagnosis, and had used OA therapies.

Results: Our study included 166 participants: mean age was 66.9 (SD 9.4) years, 48.2% women, 83.1% had a post-secondary education, and mean BMI 29.4 (SD 6.7) kg/m². Prevalence of chronic troublesome lower extremity joints was high, ranging from 31.9% (foot/ankle) to 43.4% (knee). Of 44 (26.5%) who fulfilled NICE criteria for knee OA, 29 (65.9%) had discussed their joint symptoms with a health professional (family physician most frequent) and 20 (45.5%) reported receiving any diagnosis for their joint symptoms. In those with knee OA, reported use of therapies was as follows, n (%): acetaminophen 30 (68.2), oral NSAIDs 20 (45.5); topical NSAIDs 26 (59.1); opioids 3 (6.8); joint injections 6 (13.6); physical therapy assessment 19 (43.2); physical activity and/or exercise program 15 (34.1); weight management 12 (27.3); brace 3 (0.7); gait aid 7 (15.9); and mind body activities 4 (9.1).

Conclusion: In this cross-sectional study of persons with type 2 diabetes, we confirmed a high prevalence of chronic musculoskeletal symptoms, with 43.4% reporting chronic knee symptoms and one in four fulfilling NICE criteria for knee OA. However, less than half meeting criteria for knee OA had received a diagnosis, and recommended OA treatments were underused. Further research should assess the impact of strategies to increase recognition of and diagnosis of knee OA, and improve implementation of OA care, on diabetes outcomes.

« Back to ACR Convergence 2022

ACR Meeting Abstracts - https://acrabstracts.org/abstract/underdiagnosis-and-undertreatment-of-knee-osteoarthritis-in-persons-with-type-2-diabetes-a-cross-sectional-study/