Skip to main content

An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy

Abstract

Objectives

The objectives of the study were to analyze the clinical characteristic of diabetic cheiroarthropathy (DCA) in patients with type 1 diabetes mellitus (DM), type 2 DM, and prediabetes and to evaluate the frequency of DCA among groups.

Method

The cross-sectional study was conducted at the Division of Endocrinology and Metabolism outpatient clinic over a 14-month period. A total of 239 patients (160 female, 79 male), who had type 1 DM, type 2 DM, and prediabetes, were enrolled. The demographics, clinical variables, and laboratory outcomes were recorded. Diabetic cheiroarthropathy was defined according to physical examination. The functional disability of patients with DCA was assessed by the self-administered questionnaire (disabilities of the arm, shoulder and hand-DASH).

Results

Diabetic cheiroarthropathy was determined in 35.1% of all patients. The frequency of DCA was higher in patients with prediabetes (x2 = 0.009, post hoc power = 0.794). According to the logistic regression analysis, prediabetes (OR = 4.52, 95% CI 2.16–9.47, p < 0.001), presence of polyneuropathy (OR = 3.82, 95% CI 1.61–9.07, p = 0.002), and fasting glucose level (OR = 1.01, 95% CI 1.00–1.01, p = 0.004) found as the most effective risk factors in determining DCA. DASH disability scores were significantly higher in prediabetic patients than that in type 2 DM group (p = 0.021).

Conclusion

High frequency of DCA and impaired hand function are observed in prediabetic patients. Musculoskeletal manifestations can emerge as an early sign of diabetic status. Also, people who suffer from hand involvement should be examined for diabetes along with rheumatologic diseases.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Larkin ME, Barnie A, Braffett BH, Cleary PA, Diminick L, Harth J, Gatcomb P, Golden E, Lipps J, Lorenzi G, Mahony C, Nathan DM, Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group (2014) Musculoskeletal complications in type 1 diabetes. Diabetes Care 37:1863–1869. https://doi.org/10.2337/dc13-2361

    Article  PubMed  PubMed Central  Google Scholar 

  2. Nashel J, Steen V (2012) Scleroderma mimics. Curr Rheumatol Rep 14:39–46. https://doi.org/10.1007/s11926-011-0220-8

    Article  PubMed  Google Scholar 

  3. Gerrits EG, Landman GW, Nijenhuis-Rosien L, Bilo HJ (2015) Limited joint mobility syndrome in diabetes mellitus: a minireview. World J Diabetes 6:1108–1112. https://doi.org/10.4239/wjd.v6.i9.1108

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chakravarty SD, Markenson JA (2013) Rheumatic manifestations of endocrine disease. Curr Opin Rheumatol 25:37–43. https://doi.org/10.1097/BOR.0b013e32835b4f3f

    Article  PubMed  CAS  Google Scholar 

  5. Papanas N, Maltezos E (2010) The diabetic hand: a forgotten complication? J Diabetes Complicat 24:154–162. https://doi.org/10.1016/j.jdiacomp.2008.12.009

    Article  PubMed  Google Scholar 

  6. Abate M, Schiavone C, Salini V, Andia I (2013) Management of limited joint mobility in diabetic patients. Diabetes Metab Syndr Obes 6:197–207. https://doi.org/10.2147/DMSO.S33943

    Article  PubMed  PubMed Central  Google Scholar 

  7. Serban AL, Udrea GF (2012) Rheumatic manifestations in diabetic patients. J Med Life 5:252–257

    PubMed  PubMed Central  CAS  Google Scholar 

  8. Cherqaoui R, McKenzie S, Nunlee-Bland G (2013) Diabetic cheiroarthropathy: a case report and review of the literature. Case Rep Endocrinol 2013:257028. https://doi.org/10.1155/2013/257028

    PubMed  PubMed Central  Article  Google Scholar 

  9. Bansal N (2015) Prediabetes diagnosis and treatment: a review. World J Diabetes 6:296–303. https://doi.org/10.4239/wjd.v6.i2.296

    Article  PubMed  PubMed Central  Google Scholar 

  10. American Diabetes Association (2014) Standards of medical care in diabetes--2014. Diabetes Care 37(Suppl 1):S14–S80. https://doi.org/10.2337/dc14-S014

    Article  Google Scholar 

  11. Fitzcharles MA, Duby S, Waddell RW, Banks E, Karsh J (1984) Limitation of joint mobility (cheiroarthropathy) in adult noninsulin-dependent diabetic patients. Ann Rheum Dis 43:251–254

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The upper extremity collaborative group (UECG). Am J Ind Med 29(6):602–608

    Article  PubMed  CAS  Google Scholar 

  13. Majjad A, Errahali Y, Toufik H, H Djossou J, Ghassem MA, Kasouati J, Maghraoui AE (2018) Musculoskeletal disorders in patients with diabetes mellitus: a cross-sectional study. Int J Rheumatol 2018:3839872. https://doi.org/10.1155/2018/3839872

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Gutefeldt K, Hedman CA, Thyberg ISM, Bachrach-Lindström M, Arnqvist HJ, Spångeus A (2017) Upper extremity impairments in type 1 diabetes with long duration; common problems with great impact on daily life. Disabil Rehabil 5:1–8. https://doi.org/10.1080/09638288.2017.1397202

    Article  Google Scholar 

  15. Morgan ND, Hummers LK (2016) Scleroderma mimickers. Curr Treatm Opt Rheumatol 2:69–84. https://doi.org/10.1007/s40674-016-0038-7

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zimmet P, Alberti KG, Magliano DJ, Bennett PH (2016) Diabetes mellitus statistics on prevalence and mortality: facts and fallacies. Nat Rev Endocrinol 12:616–622. https://doi.org/10.1038/nrendo.2016.105

    Article  PubMed  Google Scholar 

  17. Andréasson K, Saxne T, Bergknut C, Hesselstrand R, Englund M (2014) Prevalence and incidence of systemic sclerosis in southern Sweden: population-based data with case ascertainment using the 1980 ARA criteria and the proposed ACR-EULAR classification criteria. Ann Rheum Dis 73:1788–1792. https://doi.org/10.1136/annrheumdis-2013-203618

    Article  PubMed  Google Scholar 

  18. Labad J, Rozadilla A, Garcia-Sancho P, Nolla JM, Montanya E (2018) Limited joint mobility progression in type 1 diabetes: a 15-year follow-up study. Int J Endocrinol 2018:1897058

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Abourazzak FE, Akasbi N, Houssaini GS, Bazouti S, Bensbaa S, Hachimi H, Ajdi F, Harzy T (2014) Articular and abarticular manifestations in type 2 diabetes mellitus. Eur J Rheumatol 1:132–134. https://doi.org/10.5152/eurjrheumatol.2014.140050

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bhat TA, Dhar SA, Dar TA, Naikoo MA, Naqqash MA, Bhat A, Butt MF (2016) The musculoskeletal manifestations of type 2 diabetes mellitus in a Kashmiri population. Int J Health Sci (Qassim) 10:57–68

    PubMed Central  Google Scholar 

  21. Fatemi A, Iraj B, Barzanian J, Maracy M, Smiley A (2015) Musculoskeletal manifestations in diabetic versus prediabetic patients. Int J Rheum Dis 18:791–799. https://doi.org/10.1111/1756-185X.12712

    Article  PubMed  Google Scholar 

  22. Bañón S, Isenberg DA (2013) Rheumatological manifestations occurring in patients with diabetes mellitus. Scand J Rheumatol 42:1–10. https://doi.org/10.3109/03009742.2012.713983

    Article  PubMed  Google Scholar 

  23. Teichert T, Hellwig A, Peßler A, Hellwig M, Vossoughi M, Sugiri D, Vierkötter A, Schulte T, Freund J, Roden M, Hoffmann B, Schikowski T, Luckhaus C, Krämer U, Henle T, Herder C (2015) Association between advanced glycation end products and impaired fasting glucose: results from the SALIA study. PLoS One 10:e0128293. https://doi.org/10.1371/journal.pone.0128293

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Jiménez IU, Díaz-Díaz E, Castro JS, Ramos JP, León MC, Alvarado Ríos JA, Auriostigue Bautista JC, Correa-Rotter R, Aguilar Salinas CA, Larrea F (2017) Circulating concentrations of advanced glycation end products, its association with the development of diabetes mellitus. Arch Med Res 48:360–369. https://doi.org/10.1016/j.arcmed.2017.07.001

    Article  PubMed  CAS  Google Scholar 

  25. Redmond CL, Bain GI, Laslett LL, McNeil JD (2009) Hand syndromes associated with diabetes: impairments and obesity predict disability. J Rheumatol 36:2766–2771. https://doi.org/10.3899/jrheum.090239

    Article  PubMed  Google Scholar 

  26. Ramchurn N, Mashamba C, Leitch E, Arutchelvam V, Narayanan K, Weaver J, Hamilton J, Heycock C, Saravanan V, Kelly C (2009) Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. Eur J Intern Med 20:718–721. https://doi.org/10.1016/j.ejim.2009.08.001

    Article  PubMed  Google Scholar 

  27. Singla R, Gupta Y, Kalra S (2015) Musculoskeletal effects of diabetes mellitus. J Pak Med Assoc 65(9):1024–1027

    PubMed  Google Scholar 

  28. Petrie JR, Guzik TJ, Touyz RM (2018) Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Can J Cardiol 34(5):575–584. https://doi.org/10.1016/j.cjca.2017.12.005

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Ilker Unal for his valuable contributions on statistical analysis.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Neslihan Gokcen.

Ethics declarations

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gokcen, N., Cetinkaya Altuntas, S., Coskun Benlidayi, I. et al. An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy. Clin Rheumatol 38, 927–932 (2019). https://doi.org/10.1007/s10067-019-04454-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-019-04454-z

Keywords

  • Diabetes mellitus
  • Diabetic cheiroarthropathy
  • Function
  • Hand
  • Prediabetes