Diabetic cheiroarthropathy M14.24

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.

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).

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.

Thickening of the flexural tendon sheaths can be detected by sonography or MRI (Ismail AA et al. 1996; Khanna G et al. 2007).

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.

Diabetic chiroarthropathy is primarily diagnosed clinically (Cherqaoui R et al. 2013).

Dupuytren's contracture, carpal tunnel syndrome, tenosynovitis and sclerodactyly in the context of systemic sclerosis (scleroderma).

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.

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.

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