Cheiroarthropathy in Egyptian type 1 diabetics : correlation to microangiopathy

الملخص EN

Objectives: To determine whether LJM is associated with microvascular complications and to assess its frequency and severity in Egyptian type 1 diabetes mellitus patients.

Design: Cross-sectional study in type 1 diabetic patients & healthy controls.

Patients & Methods: Joint mobility was assessed in 50 Type 1 DM patients.

Twenty-five healthy subjects served as a control group.

The age ranged from 18 to 50 years, with a mean of 32.1±8.9.

The duration of DM ranged from 2 to 24 years with a mean of 13.3±6.4.

Joint mobility was assessed qualitatively using the prayer maneuver and quantitatively using a goniometer.

The degrees of maximal flexion & extension of the most commonly affected joints: the third & fifth metacarpo-phalangeal joints (3rd MCP& 5th MCP) & wrist were measured.

Diabetic patients were further investigated for microvascular complications in the form of: background & proliferative retinopathy by direct ophthalmoscopy, peripheral symmetrical polyneuropathy, as well as urinary albumin excretion (UAE) in at least two, 24 hour urine samples, as a marker for diabetic nephropathy.

Glycated hemoglobin HbA1c was also measured to assess longterm glucose control.

Results: Join mobility was limited in Type 1 DM patients as compared with control subjects.

The prevalence of LJM (positive prayer sign) was 40% & 8% in diabetics & healthy controls respectively (p< 0.001).

The presence of LJM in Type 1 DM patients was significantly related to the duration of diabetes & the age, but not to the sex of the patient.

Glycemic control (HbA1c) was not significantly different between diabetic patients with & without LJM.

Microangiopathies: 50% of Type 1 DM patients had retinopathy, 54% had nephropathy while 56% had neuropathy.

The prevalence of background & proliferative retinopathy was more than 2.6 fold in patients with LJM (16/20, 80%) than in those without (9/30, 30%) p<0.05.

Peripheral polyneuropathy was 2.3 fold in patients with LJM (17/20, 85%), than in others without (11/30, 36.6%) p<0.05.

Nephropathy as detected by microalbuminuria was more than 3.5 fold in patients with LJM (19/20, 95%) than in patients without (8/30, 26.6%) p<0.01.

Our results of an increased prevalence of LJM in Egyptian diabetics especially those receiving insulin treatment were in agreement with previous observations in Caucasians & Nigerians.

They also showed that LJM could predict the presence of retinopathy & nephropathy in diabetics.

Neuropathy was commoner in our patients with LJM like the Caucasian population but unlike Nigerians.

This suggests that racial factors may underlie the predictive value of LJM in diabetic microangiopathy.

Conclusion: LJM is commoner than expected in Egyptian Type 1 DM patients who have an increased risk of retinopathy, nephropathy & peripheral polyneuropathy as well.