Cheiroarthropathy

Cheiroarthropathy

Cheiroarthropathy, also known as diabetic cheiroarthropathy or limited joint mobility syndrome, is a condition characterized by the thickening and tightening of the skin on the hands and fingers, leading to restricted joint mobility. It is commonly associated with diabetes mellitus, particularly in patients with long-standing type 1 diabetes and type 2 diabetes.

Pathophysiology

The pathophysiology of cheiroarthropathy involves the accumulation of advanced glycation end-products (AGEs) in the connective tissues. AGEs are proteins or lipids that become glycated after exposure to sugars, and their accumulation is accelerated in individuals with chronic hyperglycemia, such as those with diabetes. This leads to the cross-linking of collagen fibers, resulting in the thickening and stiffening of the skin and periarticular tissues.

Clinical Presentation

Patients with cheiroarthropathy typically present with:

• Stiffness and limited range of motionin the small joints of the hands, particularly the metacarpophalangeal and interphalangeal joints.
• Thickened, waxy skinon the dorsal aspect of the hands.
• Inability to fully extend the fingers, often described as the "prayer sign" or "tabletop sign," where patients are unable to press their palms together completely or lay their hands flat on a table.

Diagnosis

The diagnosis of cheiroarthropathy is primarily clinical, based on the characteristic physical findings. However, it is important to differentiate it from other conditions that can cause joint stiffness and skin changes, such as scleroderma or Dupuytren's contracture.

Management

There is no specific treatment for cheiroarthropathy, but management focuses on controlling blood glucose levels to prevent further progression. Physical therapy and exercises to maintain joint mobility can be beneficial. In some cases, occupational therapy may be recommended to assist with daily activities.

Prognosis

While cheiroarthropathy itself is not life-threatening, it can significantly impact the quality of life by limiting hand function. It is also considered a marker for microvascular complications in diabetes, such as diabetic retinopathy and diabetic nephropathy.

Also see

• Diabetes mellitus
• Advanced glycation end-products
• Scleroderma
• Dupuytren's contracture