Abdalla Elham, Gamar Abrar Mohamed, Taha Ziryab Imad, Alfatih Mohammed
Department of Internal Medicine, Bahri University, Khartoum Sudan.
Faculty of Medicine, Al-Zaiem Al-Azhari University, Khartoum, Sudan/Clinical Immunology Resident, Sudan Medical Specialization Board, Khartoum, Sudan.
Ann Med Surg (Lond). 2024 Mar 21;86(6):3631-3635. doi: 10.1097/MS9.0000000000001993. eCollection 2024 Jun.
Diabetic cheiroarthropathy, also known as limited joint mobility, is one of the long-standing complications of type 2 diabetes mellitus (DM). It affects 8-50% of patients with type 1 diabetes and is also seen in type 2 diabetic patients. Consequently, it can mimic many rheumatological diseases and is often underdiagnosed. The authors present a case of a long-standing poorly controlled diabetes with diabetic cheiroarthropathy and diabetic neuropathy, along with positive ANA in the absence of any correlated autoimmune or rheumatological diseases.
A 52-year-old female patient with poorly controlled diabetes (her last HbA1c reading was 9.5%) presented to the Rheumatology clinic with flexion deformities of the fingers. The patient has impaired vibration, two-point discrimination, and pinprick sensation in gloves and stock distribution, indicating peripheral neuropathy, entrapment neuropathy in the forms of bilateral carpal tunnel syndrome, and the diagnosis of diabetic cheiroarthropathy was made. Additionally, she has a positive prayer sign and a tabletop sign. Despite the absence of symptoms and signs of autoimmune disorders, this patient has positive anti-nuclear antibodies global (ANA positive by indirect immuno-fluorescence (IIF) 1\320 nucleolar pattern) with a negative: ANA profile, rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (ACPA).
Regular and careful hand examination should be part of clinical assessment for diabetic patients as it could be a very simple and useful screening tool for diabetic cheiroarthropathy. Physicians can use this condition as a mirror for microvascular complications of diabetes. This allows for early detection and appropriate interventions to prevent further progression of diabetes-related complications. It is also essential to consider the presence of positive ANA in diabetic cheiroarthropathy despite the absence of any rheumatological and autoimmune diseases.
糖尿病性手部关节病，也称为关节活动受限，是2型糖尿病（DM）的长期并发症之一。它影响8% - 50%的1型糖尿病患者，在2型糖尿病患者中也可见。因此，它可模仿许多风湿性疾病，且常被漏诊。作者报告一例长期血糖控制不佳的糖尿病患者，伴有糖尿病性手部关节病和糖尿病性神经病变，同时抗核抗体阳性，但无任何相关的自身免疫性或风湿性疾病。
一名52岁女性患者，糖尿病控制不佳（其末次糖化血红蛋白读数为9.5%），因手指屈曲畸形就诊于风湿病诊所。患者存在手套和袜套样分布的振动觉、两点辨别觉及针刺觉减退，提示周围神经病变、双侧腕管综合征形式的卡压性神经病变，并诊断为糖尿病性手部关节病。此外，她有阳性祈祷征和桌面征。尽管没有自身免疫性疾病的症状和体征，但该患者抗核抗体总体呈阳性（间接免疫荧光法（IIF）检测抗核抗体1:320，核仁型），而抗核抗体谱、类风湿因子（RF）和抗环瓜氨酸肽抗体（ACPA）均为阴性。
定期且仔细的手部检查应成为糖尿病患者临床评估的一部分，因为它可能是糖尿病性手部关节病非常简单且有用的筛查工具。医生可将这种情况视为糖尿病微血管并发症的一个反映。这有助于早期发现并进行适当干预，以防止糖尿病相关并发症的进一步发展。尽管没有任何风湿性和自身免疫性疾病，但在糖尿病性手部关节病中考虑抗核抗体阳性的情况也很重要。
