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Roca-Espiau M, Andrade-Campos M, Cebolla JJ, López de Frutos L, Medrano-Engay B, López-Royo MP, Giraldo P. Muscle-tendon weakness contributes to chronic fatigue syndrome in Gaucher's disease. J Orthop Surg Res 2019; 14:383. [PMID: 31752949 PMCID: PMC6873505 DOI: 10.1186/s13018-019-1452-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/31/2019] [Indexed: 01/31/2023] Open
Abstract
Background Chronic fatigue (CFg) is a prevalent symptom in Gaucher disease (GD) at diagnosis (79%) and remains in a quarter of patients after years of therapy. Bone abnormalities are present in over 70% and peripheral neuropathy in about 11% of the patients, which contributes to the disabling and debilitating complications. Our hypothesis is that other factors such as muscle-tendinous weakness could have influence in the development of CFg. Methods We have evaluated the fiber structure and elasticity of muscle-tendinous unit by strain-elastography (S-ELA) and analyzed their influence in the CFg. S-ELA study was performed in Achilles tendon in 25 type 1 and two type 3 GD patients, all of them with fatigue and were on enzymatic replacement therapy for mean 13 years; simultaneously, bone marrow burden by MRI and calcaneus ultrasound densitometry were evaluated. Blood cell counts, plasma biomarkers, GBA1 genotyping, and SF36 quality of life scale (QoL) were also performed. Statistical analysis: descriptive and comparative test. Results All patients showed a normal Achilles tendinous structure. Abnormal stiff grade 2–3 was found in 17/27 (62.9%); in 11/27 (40.7%) of patients, the alteration was bilateral. There were no correlations between the S-ELA results to other variables; nevertheless, a significant correlation between the degree of tendon hardness and the low score on the QoL scales (p = 0.0035) was found. The S-ELA is a sensitive painless, fast, and low cost method to detect muscle-tendinous subclinical dysfunction that could contribute to CFg in GD. The identification of subclinical tendon alteration would be a sign of alarm, focused on the risk of development of bone complications. Conclusion Intratendinous alteration in strain-elastography is an independent variable in GD patients with persistent fatigue.
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Affiliation(s)
- Mercedes Roca-Espiau
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain.,Radiologic Centre CEMEDI, Zaragoza, Spain
| | - Marcio Andrade-Campos
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain.,Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Departamento de Hematología, Hospital del Mar, Barcelona, Spain
| | - Jorge J Cebolla
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain.,Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, Spain
| | - Laura López de Frutos
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain.,Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Blanca Medrano-Engay
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain.,Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Maria-Pilar López-Royo
- Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,iPhysio Group, Universidad San Jorge, Zaragoza, Spain
| | - Pilar Giraldo
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain. .,Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.
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Evranos B, Idilman I, Ipek A, Polat SB, Cakir B, Ersoy R. Real-time sonoelastography and ultrasound evaluation of the Achilles tendon in patients with diabetes with or without foot ulcers: a cross sectional study. J Diabetes Complications 2015; 29:1124-9. [PMID: 26382616 DOI: 10.1016/j.jdiacomp.2015.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/04/2015] [Accepted: 08/17/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is an endocrine disease characterized by metabolic abnormalities and long-term complications. The Achilles tendon (AT) plays an important role in foot biomechanics. We aimed to investigate the effect of DM on the Achilles tendon, which may contribute to long-term complications in the foot-ankle complex. METHODS Seventy-eight patients with diabetes, with (35 patients, group I) or without (43 patients, group II) foot ulcers were recruited from the endocrinology clinic. Thirty-three age-, gender-, and BMI-matched healthy individuals were selected as controls. All participants underwent ultrasonography and sonoelastography of their AT in order to evaluate Achilles tendon thickness (ATT) and stiffness (ATS). Each patient was also tested for fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1C) as a measure of diabetes control. Other chronic complications were also evaluated in all patients with diabetes. RESULTS The AT was significantly thicker in group I compared to group II and the controls. HbA1C, FPG, and duration of diabetes were higher in group I. We observed that ATT was positively correlated with neuropathy, retinopathy, nephropathy, peripheral arterial disease and coronary arterial disease in group II while this correlation was not detected in group I. ATS was reduced in group I more than group II and control groups. CONCLUSION Changes in the structure of the AT may precede foot ankle disorders in patients with diabetes. This is the first study that reported the results of sonoelastosonography of AT in patients with diabetes and revealed the correlation between ATT and other chronic complications of diabetes.
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Affiliation(s)
- Berna Evranos
- Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey.
| | - Ilkay Idilman
- Ataturk Education and Research Hospital, Radiology Department, Ankara, Turkey
| | - Ali Ipek
- Ataturk Education and Research Hospital, Radiology Department, Ankara, Turkey
| | - Sefika Burcak Polat
- Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey
| | - Bekir Cakir
- Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey
| | - Reyhan Ersoy
- Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey
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