Diabetic cheiroarthropathyM14.24
Synonym(s)
DefinitionThis section has been translated automatically.
Peculiar thickening of the skin of the hands combined with a reduced mobility of the fingers, a phenomenon that becomes evident mainly when stretching the fingers. A characteristic feature is the "Prayer sign", i.e. the inability to bring the palms and fingers into two-dimensional contact with each other (Raman PG et al. 2003). A further characteristic is the "table top sign", i.e. the inability to contact a flat table surface with the palms completely flat.
Occurrence/EpidemiologyThis section has been translated automatically.
In a larger study (n=239 patients) with diabetic and pre-diabetic patients, diabetic cheiroarthropathy occurred in 35.1% of cases (Gokcen N et al. 2019).
EtiopathogenesisThis section has been translated automatically.
Diabetic microangiopathy and AGEs are discussed as causes of diabetic chiroarthropathy. The consequences are ischemia and activation of profibrotic signaling pathways in the dermis. The glycation of collagen and other matrix proteins alters the biomechanical properties and metabolism of these molecules.
ImagingThis section has been translated automatically.
Thickening of the flexural tendon sheaths can be detected by sonography or MRI (Ismail AA et al. 1996; Khanna G et al. 2007).
HistologyThis section has been translated automatically.
Dermatohistopathological correlate of clinical symptoms are thickened and organized collagen fibers in the dermis as well as mucin deposits. Furthermore, there is a thickening of the periarticular structures.
DiagnosisThis section has been translated automatically.
Diabetic chiroarthropathy is primarily diagnosed clinically (Cherqaoui R et al. 2013).
Differential diagnosisThis section has been translated automatically.
Dupuytren's contracture, carpal tunnel syndrome, tenosynovitis and sclerodactyly in the context of systemic sclerosis (scleroderma).
TherapyThis section has been translated automatically.
Therapeutically, aldose reductase inhibitors have so far disappointed. Symptomatically, non-steroidal anti-inflammatory drugs can be given in the interval. Furthermore, physiotherapeutic measures are used to maintain joint mobility.
Note(s)This section has been translated automatically.
The involvement of multiple joints in diabetic cheiroarthropathy is considered an important early complication in children with type I diabetes mellitus. Diabetic cheiroarthropathy correlates with the extent of diabetic metabolic status. Affected patients are at increased risk for the coexistence of microvasculopathy, diabetic retinopathy and/or nephropathy.
LiteratureThis section has been translated automatically.
- Cherqaoui R et al (2013) Diabetic cheiroarthropathy: a case report and review of the literature. Case Rep Endocrinol:257028. doi: 10.1155/2013/257028.
- Gokcen N et al (2019) An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy. Clin Rheumatol 38:927-932.
- Ismail AA et al. (1996) Ultrasonographic features of diabetic cheiroarthropathy. Br J Rheumatol 35:676-679.
- Khanna G et al (2007) MRI of diabetic cheiroarthropathy. AJR Am J Roentgenol 188: W94-95.
- Kashyap AS et al (2009) Diabetic cheiroarthropathy. Postgrad Med J 85:43.
- Kuczmarski AS et al.(2018) Management of Diabetic Trigger Finger. J Hand Surg On 44:150-153.
- Raman PG et al.(2003) Prayer sign. Diabetic cheiroarthropathy. J Assoc Physicians India 51:1077.