Quantification of joint mobility limitation in adult type 1 diabetes

Abstract

AbstractBackgroundDiabetic cheiroarthropathies consist of limited joint mobility (LJM), flexor tenosynovitis (FTS), Dupuytren’s contracture (DC), and carpal tunnel syndrome (CTS). There is heterogeneity in definitions and lack of a method to measure hand fibrosis load. We measured metacarpophalangeal (MCP) joint restriction and describe magnetic resonance (MR) imaging characteristics across the spectrum of joint restriction.MethodsAdults with type 1 diabetes were screened for hand manifestations using a symptom questionnaire, clinical examination, function (Duruoz hand index (DHI), grip strength). We measured maximum possible extension at the MCP joint. Patients were segregated by mean MCP extension (<20 degrees, 20-40 degrees, 40-60 degrees, and >60 degrees) for MRI scanning. Patients in the four groups were compared using ANOVA for clinical features as well as MRI measurements (tenosynovial, skin, and fascia thickness, additive score of three).FindingsOf 237 patients (90 males), 79 (33.8%) had cheiroarthropathy; these had MCP extension limitation (39 degrees versus 61 degrees, p<0.01). Groups with restricted MCP extension were older, had higher prevalence of retinopathy and nephropathy, and higher DHI (1.9 vs 0.2) but very few (7%) had pain. MRI scans of the hand (n=61) showed flexor tenosynovitis in four and median neuritis in one. Groups with maximum MCP limitation had the thickest palmar skin but mean tendon thickness or median nerve area did not differ. The additive score could differentiate between levels of joint mobility restriction. Only mean palmar skin thickness was associated with MCP extension angle in multiple linear regression.InterpretationJoint mobility limitation, quantified by restricted MCP extension, was driven by skin thickening. MCP extension and fibrosis scoring on MRI can serve as quantitative measures of hand involvement for future associative studies.