“Association Between Serum Inflammatory Lipoproteins and Adhesive Capsulitis Accompanied By Diabetes-A Case Control Study”

Abstract

Background: Adhesive capsulitis is common and can cause stiffness and pain. Diabetes and dyslipidemia are known to be associated with adhesive capsulitis. However, there is no report of any association between serum lipid levels accompanied by diabetes patients. Objective: To assess association between serum inflammatory lipoproteins and adhesive capsulitis accompanied by diabetes. Methods: This is a case-control study was conducted in Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. We investigated all the patients who visited our clinic because of their shoulder problems from January to June-2017. Among those patients, 375 were diagnosed with adhesive capsulitis. Of these, we excluded 44 patients (11%) who had no laboratory results. Individuals with normal shoulder function (bilaterally pain-free, with full range of motion and no shoulder muscle weakness), no thyroid dysfunction, and no previously diagnosed systemic diseases. Individuals in the first control group had neither adhesive capsulitis nor diabetes. Individuals in the second control group had newly diagnosed diabetes without adhesive capsulitis. Results: Demographic data, serum lipid levels, and the prevalence of dyslipidemia for the 25 patients with adhesive capsulitis accompanied by diabetes and 75 individuals of two control groups were matched by age and sex. For the patients with adhesive capsulitis, the mean duration of symptoms was 5.8±2.7 months; the median interval between initial examination and blood sampling was 6.0 days (interquartile range [IQR], 1.0–8.0). Low-density lipoprotein and non HDL were associated with adhesive capsulitis accompanied by diabetes. Specifically, patients with adhesive capsulitis and diabetes had greater odds ratios of hyperlow-density lipoproteinemia when compared with individuals with neither adhesive capsulitis nor diabetes (OR, 3.19; 95% CI, 1.21–8.38; p =0.019) and when compared with individuals without adhesive capsulitis but with newly diagnosed diabetes (OR, 5.76; 95% CI, 1.67–19.83; p= 0.005). Similarly, patients with adhesive capsulitis accompanied by diabetes had greater odds ratios of hypernonhigh-density lipoproteinemia when compared with individuals with neither adhesive capsulitis nor diabetes (OR, 7.39; 95% CI, 2.72–20.09; p < 0.001) and when compared with individuals without adhesive capsulitis but with newly diagnosed diabetes (OR, 3.26; 95% CI, 1.40–7.61; p = 0.006). Conclusions: Inflammatory lipoproteinemias, particularly hyperlow-density lipoproteinemia and hypernonhighdensity lipoproteinemia, are associated with adhesive capsulitis accompanied by diabetes. Further research is needed to evaluate whether inflammatory lipoproteinemias are a cause, a related cofactor, or an aggravating factor in the development of adhesive capsulitis in people who have diabetes.