Metabolic Dysfunction in Arthritis

Healthy bones and joints depend on a normally functioning endocrine system. It is a fact of clinical significance that excess IGF-I and growth hormone (GH) causes major joint pathology (Stavrou and Kleinberg 2001). Endocrine disorders not only affect soft connective tissues but also implicate load-bearing musculoskeletal structures including bone, cartilage, synovium, tendon, and ligament. Damage to soft connective tissue and associated innervation is a hallmark of acromegaly, hypothyroidism,and diabetes mellitus (Liote and Orcel 2000). Acromegaly normally presents with quite severe arthritis involving degeneration of the spine and articular cartilage in peripheral joints (Stavrou and Kleinberg 2001). Severe diabetes mellitus increases the risk of neuroarthropathy as a direct result of infection, neuropathy, and vasculopathy. Pituitary tumors can have manifestations similar to rheumatological disease and may cause connective tissue disorders as a result of overproduction or deficiencies of pituitary hormones (Stavrou and Kleinberg 2001). Excessive GH production by the pituitary gland causes cartilage destruction. GH deficiency on the other hand increases the risk of bone fractures.