{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:53:06Z","timestamp":1791341586210,"version":"4.3.1"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Adv Rheumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Musculoskeletal complications represent a significant burden in diabetes, yet the distinct presentation between Type 1 (T1DM) and Type 2 Diabetes Mellitus (T2DM) remains under-characterized. This study aimed to evaluate and quantify the burden of rheumatic manifestations and subclinical enthesopathy in these two distinct clinical phenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional analysis of 65 patients (21 T1DM, 44 T2DM). A comprehensive rheumatological evaluation assessed adhesive capsulitis (defined as painful restriction of active and passive motion in \u2265\u20092 planes), knee osteoarthritis (per American College of Rheumatology clinical classification criteria), cheiroarthropathy, and soft tissue rheumatism. High-resolution musculoskeletal ultrasound evaluated five bilateral entheseal sites using the Glasgow Ultrasound Enthesitis Scoring System (GUESS). Effect sizes (Cohen\u2019s d) and 95% Confidence Intervals (CI) were calculated to assess the magnitude of intergroup differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The T2DM phenotype was characterized by older age and higher BMI compared to T1DM. T2DM patients exhibited a markedly higher prevalence of adhesive capsulitis, knee osteoarthritis, and anserine bursitis. Ultrasound revealed a substantially higher enthesopathy burden in the T2DM group, with a mean GUESS score of 6.8\u2009\u00b1\u20092.1 compared to 1.1\u2009\u00b1\u20090.2 in T1DM. The effect size for the difference in enthesopathy scores (Cohen\u2019s d\u2009=\u20093.29) exceeded the effect size for the age difference (d\u2009=\u20092.79), suggesting that the observed structural burden may not be fully explained by age alone. Available HbA1c data showed similarly suboptimal glycemic control in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>T2DM was associated with a higher burden of structural entheseal abnormalities and higher GUESS scores compared with T1DM. These findings may reflect the combined influence of obesity, metabolic factors, and age. Interpretation should consider baseline demographic differences between groups and the broad clinical definitions employed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42358-026-00544-0","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T08:46:04Z","timestamp":1779180364000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The distinct musculoskeletal phenotypes of Type 1 and Type 2 diabetes: a sonographic characterization of enthesopathy burden"],"prefix":"10.1186","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6619-8855","authenticated-orcid":false,"given":"Adel Ibrahim","family":"Azzam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taha Ibrahim","family":"Aladrosy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad","family":"Ghanem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf Abdelsalam","family":"Moustafa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatem","family":"Saadeldin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazeed Mohammed","family":"AlZahrani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilal Rajeh","family":"AlZahrani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afrah Abdulraheem","family":"Alshahrani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Altowairqi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Almalki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"issue":"1","key":"544_CR1","doi-asserted-by":"publisher","first-page":"100498","DOI":"10.1016\/j.clinme.2025.100498","volume":"26","author":"H Ward","year":"2026","unstructured":"Ward H, Jawad AS. Musculoskeletal manifestations of diabetes mellitus - an update. Clin Med (Lond). 2026;26(1):100498. https:\/\/doi.org\/10.1016\/j.clinme.2025.100498.","journal-title":"Clin Med (Lond)"},{"issue":"11","key":"544_CR2","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1093\/qjmed\/hcv106","volume":"108","author":"M Merashli","year":"2015","unstructured":"Merashli M, Chowdhury TA, Jawad AS. Musculoskeletal manifestations of diabetes mellitus. QJM. 2015;108(11):853\u20137. https:\/\/doi.org\/10.1093\/qjmed\/hcv106.","journal-title":"QJM"},{"issue":"1","key":"544_CR3","doi-asserted-by":"publisher","first-page":"26","DOI":"10.11138\/mltj.6.1.026","volume":"6","author":"NH Zreik","year":"2016","unstructured":"Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J. 2016;6(1):26\u201334. https:\/\/doi.org\/10.11138\/mltj.6.1.026.","journal-title":"Muscles Ligaments Tendons J"},{"issue":"12","key":"544_CR4","doi-asserted-by":"publisher","first-page":"1730","DOI":"10.1136\/annrheumdis-2018-213609","volume":"77","author":"PV Balint","year":"2018","unstructured":"Balint PV, Terslev L, Aegerter P, et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis. 2018;77(12):1730\u20135. https:\/\/doi.org\/10.1136\/annrheumdis-2018-213609.","journal-title":"Ann Rheum Dis"},{"key":"544_CR5","doi-asserted-by":"publisher","first-page":"1759720X2412718","DOI":"10.1177\/1759720X241271886","volume":"16","author":"JC Williams","year":"2024","unstructured":"Williams JC, Hum RM, Rogers K, Maglio C, Alam U, Zhao SS. Metabolic syndrome and psoriatic arthritis: the role of weight loss as a disease-modifying therapy. Ther Adv Musculoskelet Dis. 2024;16:1759720X241271886. https:\/\/doi.org\/10.1177\/1759720X241271886.","journal-title":"Ther Adv Musculoskelet Dis"},{"issue":"1","key":"544_CR6","first-page":"87","volume":"236","author":"PE Arkkila","year":"1994","unstructured":"Arkkila PE, Kantola IM, Viikari JS. Limited joint mobility in type 1 diabetic patients: correlation with other diabetic complications. J Intern Med. 1994;236(1):87\u201392.","journal-title":"J Intern Med"},{"issue":"10","key":"544_CR7","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1136\/ard.61.10.905","volume":"61","author":"PV Balint","year":"2002","unstructured":"Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002;61(10):905\u201310. https:\/\/doi.org\/10.1136\/ard.61.10.905.","journal-title":"Ann Rheum Dis"},{"issue":"1","key":"544_CR8","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1136\/bjsm.37.1.30","volume":"37","author":"L Smith","year":"2003","unstructured":"Smith L, Burnet S, McNeil J. Musculoskeletal manifestations of diabetes mellitus. Br J Sports Med. 2003;37(1):30.","journal-title":"Br J Sports Med"},{"issue":"3","key":"544_CR9","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.jmu.2017.03.011","volume":"25","author":"SC Okur","year":"2017","unstructured":"Okur SC, Dogan YP, Mert M, Aksu O, Burnaz O, Caglar NS. Ultrasonographic evaluation of lower extremity entheseal sites in diabetic patients using Glasgow Ultrasound Enthesitis Scoring System score. J Med Ultrasound. 2017;25(3):150\u20136. https:\/\/doi.org\/10.1016\/j.jmu.2017.03.011.","journal-title":"J Med Ultrasound"},{"issue":"4","key":"544_CR10","doi-asserted-by":"publisher","first-page":"258","DOI":"10.5152\/eurjrheum.2018.18044","volume":"5","author":"T S\u00f6zen","year":"2018","unstructured":"S\u00f6zen T, Ba\u015faran N, T\u0131nazl\u0131 M, \u00d6z\u0131\u015f\u0131k L. Musculoskeletal problems in diabetes mellitus. Eur J Rheumatol. 2018;5(4):258\u201365. https:\/\/doi.org\/10.5152\/eurjrheum.2018.18044.","journal-title":"Eur J Rheumatol"},{"key":"544_CR11","doi-asserted-by":"publisher","first-page":"1491633","DOI":"10.3389\/fphar.2024.1491633","volume":"15","author":"J Xu","year":"2024","unstructured":"Xu J, Wang J, Ji Y, et al. The impact of diabetes mellitus on tendon pathology: a review. Front Pharmacol. 2024;15:1491633. https:\/\/doi.org\/10.3389\/fphar.2024.1491633.","journal-title":"Front Pharmacol"},{"issue":"7","key":"544_CR12","doi-asserted-by":"publisher","first-page":"1863","DOI":"10.2337\/dc13-2361","volume":"37","author":"ME Larkin","year":"2014","unstructured":"Larkin ME, Barnie A, Braffett BH, et al. Musculoskeletal complications in type 1 diabetes. Diabetes Care. 2014;37(7):1863\u20139. https:\/\/doi.org\/10.2337\/dc13-2361.","journal-title":"Diabetes Care"},{"issue":"6","key":"544_CR13","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1016\/S0002-9343(02)01045-8","volume":"112","author":"E Cagliero","year":"2002","unstructured":"Cagliero E, Apruzzese W, Perlmutter GS, Nathan DM. Musculoskeletal disorders of the hand and shoulder in patients with diabetes mellitus. Am J Med. 2002;112(6):487\u201390. https:\/\/doi.org\/10.1016\/S0002-9343(02)01045-8.","journal-title":"Am J Med"},{"issue":"7","key":"544_CR14","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1002\/acr.21938","volume":"65","author":"YP Huang","year":"2013","unstructured":"Huang YP, Fann CY, Chiu YH, et al. Association of diabetes mellitus with the risk of developing adhesive capsulitis of the shoulder: a longitudinal population-based followup study. Arthritis Care Res (Hoboken). 2013;65(7):1197\u2013202. https:\/\/doi.org\/10.1002\/acr.21938.","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"1","key":"544_CR15","doi-asserted-by":"publisher","first-page":"136","DOI":"10.2337\/dc16-2042","volume":"40","author":"R Pop-Busui","year":"2017","unstructured":"Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136\u201354. https:\/\/doi.org\/10.2337\/dc16-2042.","journal-title":"Diabetes Care"},{"issue":"8","key":"544_CR16","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1002\/art.1780290816","volume":"29","author":"R Altman","year":"1986","unstructured":"Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039\u201349. https:\/\/doi.org\/10.1002\/art.1780290816.","journal-title":"Arthritis Rheum"},{"issue":"1","key":"544_CR17","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1038\/s41572-019-0092-1","volume":"5","author":"EL Feldman","year":"2019","unstructured":"Feldman EL, Callaghan BC, Pop-Busui R, et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019;5(1):42. https:\/\/doi.org\/10.1038\/s41572-019-0092-1.","journal-title":"Nat Rev Dis Primers"}],"container-title":["Advances in Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42358-026-00544-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42358-026-00544-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42358-026-00544-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:01:25Z","timestamp":1779793285000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42358-026-00544-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["544"],"URL":"https:\/\/doi.org\/10.1186\/s42358-026-00544-0","relation":{},"ISSN":["2523-3106"],"issn-type":[{"value":"2523-3106","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"assertion":[{"value":"18 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was approved by the Ethics Committee of the Faculty of Medicine, Al-Azhar University. Written informed consent was obtained from all participants prior to their inclusion in the study, in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"36"}}