Know What Uncontrolled Diabetes Mellitus Can Do!

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Diabetic Stiff Hand

Diabetes Mellitus showed its true colors when left uncontrolled and affected multiple organs!

A 50-year-old female, known case of diabetes mellitus for the past 10 years, presented to the rheumatology clinic with complaints of pain and stiffness bilaterally in her hands for the past 1 year.

The patient revealed that the stiffness remains for the entire day. Since she denied any other symptoms, including skin discoloration secondary to cold, dysphagia, dry eyes, dry mouth, etc., an alternate diagnosis was ruled out. ربح الاموال

Her last follow-up visit for diabetes was one year back. After a year of absence, she had presented with complaints of joint pain, stiffness, and uncontrolled glucose levels.

Although the patient was taking oral hypoglycemics, her HbA1C (glycosylated hemoglobin) level was 10% during the current presentation.

On examination, the patient limited mobility across all her hand joints. ماكينات القمار على الانترنت The skin over the hands was thick, tight, and waxy. She was unable to flex or extend her fingers fully. Heberden’s nodes were noticeable in the distal interphalangeal joints on both the hands indicating osteoarthritis.

Positive Signs in Diabetes Mellitus related complications:

Positive prayer sign:
When she was asked to put her hands together in a praying position with the fingers apart (abducted), attempting to approximate the palmar surfaces of the interphalangeal joints and the palms, the patient could not approximate. So she a positive prayer signs.

Positive tabletop sign
She was asked to place her hands in a palms-down position on a horizontal surface but her hands could not lie flat. Therefore, she had a positive tabletop sign too.

Positive Prayer Sign

Tinel’s and Phalen’s tests were negative and there were no signs of Duputren’s contracture or flexors tendons synovitis.

Serology revealed normal levels of ESR and CRP. Rheumatoid factors and anti-CCP were negative,

Radiographs of her hands showed mild osteoarthritis.

The patient was diagnosed with Diabetic Cherioarthropathy.

Differential Diagnosis:

Positive prayer and tabletop signs point towards limited joint mobility. Diabetic Cherioarthropathy is one of the differential diagnoses. others include Dupuytren contracture, palmar fasciitis, tenosynovitis of the finger flexor tendons, reflex sympathetic dystrophy, and scleroderma.

Since the patient had no clinical or laboratory clues to suggest alternate diagnoses, and she had uncontrolled DM and high HbA1C, so the diagnosis was confirmed to be Diabetic Cherioarthropathy. Although it is a rare diagnosis, it is imperative to reach a correct diagnosis so that unnecessary treatments can be avoided and the actual culprit can be caught in time

The patient was advised to maintain her blood sugar levels. Follow-up with her primary care physician for tight control of her diabetes mellitus was highly recommended.

Further workup done by her primary care physician showed microalbuminuria indicating diabetes nephropathy and non-proliferative diabetes retinopathy.

The patient was suffering from complications of diabetes mellitus. مواقع الرهان على المباريات In such cases, the best strategy is to have tight glycemic control with lifestyle changes and adequate hypoglycemic treatment/s. These steps help to delay or stop the progression of diabetic complications.

References:

Upreti V, Vasdev V, Dhull P, Patnaik SK. Prayer sign in diabetes mellitus. Indian J Endocrinol Metab. 2013;17(4):769-770. doi:10.4103/2230-8210.113784

Raina S, Jaryal A, Sonnatakke T. Prayer sign. Indian Dermatol Online J. 2013;4(3):259. doi:10.4103/2229-5178.115545

Edrees A (2020) Diabetic Cherioarthropathy, a Clue for Uncontrolled Diabetes: Case Report and Review of the Literature. Clin Med Rev Case Rep 7:327. doi.org/10.23937/2378-3656/1410327

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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