Connective tissue disorders in diabetes

Rosenbloom, Arlan L.

doi:10.1002/9781118387658.ch65

Cited by 5 publications

(10 citation statements)

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“…The changes in the LJM syndrome usually begin in the metacarpo-phalangeal and proximal inter-phalangeal joints of the fifth finger and gradually extend laterally. As a result, the patient will not be able to approximate the palm and fingers of the hands[1013] Reissell et al . have speculated that glycosylation of the joints of the larynx and cervical vertebral region may be responsible for the increased incidence of difficult intubation.…”

Section: Discussionmentioning

confidence: 99%

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Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices

Hashim¹,

Thomas²

2014

Indian J Anaesth

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Background and Aims:Diabetic patients are prone for the limited joint mobility syndrome. The atlanto-occipital joint involvement limits adequate extension of head and neck during laryngoscopy making intubation difficult. The collagen glycosylation starts in the fourth and fifth inter-phalangeal joints. The degree of inter-phalangeal involvement can be assessed by scoring the ink impression made by the palm of the dominant hand (palm print [PP] sign) The aim of our study was to evaluate the PP sign as a screening tool for predicting difficult laryngoscopy in diabetic patients.Methods:A total of 60 diabetic patients undergoing general anaesthesia with endotracheal intubation were assessed pre-operatively for their airway indices using the modified Mallampati test, thyromental distance, degree of head extension, the PP test and the prayer sign and their corresponding Cormack–Lehane scores were noted. Statistical analysis was performed using Fischer exact test.Results:Of the 60 patients, 15 had positive PP sign. Of the 13 difficult laryngoscopies encountered, 10 patients had a positive PP sign. PP sign was the most sensitive index in predicting difficult laryngoscopy. P =0.000 was obtained and considered as statistically significant. The sensitivity was 76.9%, specificity 89.4%, positive and negative predictive value 71.4% and 91.3% and accuracy 86.7%, respectively. The other signs were not significant in predicting difficult laryngoscopy.Conclusion:The PP test appears to be the most sensitive and specific in the prediction of difficult laryngoscopy in diabetic patients.

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Section: Discussionmentioning

confidence: 99%

“…[1013] Diabetic patients have an abnormality of collagen metabolism and increased cross-link formation as a result of which collagen fibrils are abnormally stable, relatively insoluble and resistant to the enzymatic degradation[1014] These changes are potentially reversible. [1015]…”

Section: Introductionmentioning

confidence: 99%

Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices

Hashim¹,

Thomas²

2014

Indian J Anaesth

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“…There should also be no basis for confusion because of the absence of palmar fas-cial thickening and nodules in LJM, and the finger distribution differs. All the other conditions, in addition to not occurring in children and adolescents with T1D, are associated with pain and other characteristic findings, as noted in Table 1 (16).…”

Section: Differential Diagnosismentioning

confidence: 92%

Limited Joint Mobility in Childhood Diabetes: Discovery, Description, and Decline

Rosenbloom

2013

The Journal of Clinical Endocrinology & Metabolism

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Context:The discovery of limited joint mobility (LJM) as the earliest clinically apparent complication of diabetes in children and adolescents nearly 40 years ago provided insights into the mechanism of diabetes complications.Results: LJM, due to periarticular connective tissue thickening and stiffness, varied from single joint involvement bilaterally to obvious hand deformity and limitation of movement of the spine. Thick, tight, waxy skin was apparent with more severe changes; biopsy indicated thickening of the dermis and epidermis with accumulation of collagen and loss of skin appendages. Substantial growth impairment was associated with all levels of LJM. Risk for microvascular disease over a 16-year period was actuarially increased nearly 4-fold by the presence of LJM. Long-term glycemic control influenced the onset of LJM; for every unit increase in average glycated hemoglobin from onset there was a 46% increase in the risk of LJM. Between 1976 -78 and 1998, the prevalence of LJM decreased from 30 to 7%, and the portion with moderate to severe changes decreased from 33 to 14%, with the disappearance of severely affected individuals. Furthermore, growth data markedly improved for those with and without LJM; 30% without LJM and 77% with LJM had been less than the 25th percentile for height, whereas the more contemporary group had 22% without LJM and 33% with LJM in this quartile. Conclusions:The elucidation of LJM as a novel and informative early complication of pediatric diabetes has provided insights into the evolution of the severe long-term complications of diabetes. The marked decrease in the frequency of LJM and statural deficit in children and youth with diabetes in the 20 years between the late 1970s and 1990s can be attributed to improved metabolic control of children and adolescents. The prevalence of LJM in a population may serve as a measure of quality of diabetes control. Discovery In the early 1970s, 3 older teenagers who had long-standing type 1 diabetes (T1D) were referred to the University of Florida pediatric diabetes clinic with striking limitation of extension and flexion of the interphalangeal (IP), metacarpophalangeal (MCP), wrist, elbow, and ankle joints-and in 2 of them, the spine-in association with short stature, thick, tight, waxy skin; delayed sexual maturation; and early microvascular complications (Figure 1) (1). Limitation appeared to be due to periarticular thickening and stiffness; radiography revealed normal joints and confirmed thickening of the periarticular tissues. These observations were followed by the description of milder manifestations in 28% of 229 campers with diabetes aged 7-18 years (2, 3). It is remarkable that these findings, particularly the more advanced changes, would not be described until more than half a century after the rescue and survival of children with T1D by insulin. DescriptionChanges were seen to begin in the MCP and proximal IP (PIP) joints of the little finger and extend radially; and in

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“…However, some studies reported that, in young patients, the prevalence of LJM increases after 5 to 10 years of diabetes . In this regard, the young age and the limited disease duration of patients involved in this study could explain the lack of a relationship between AJM and disease duration.…”

Section: Discussionmentioning

confidence: 65%

“…Despite recent advances in patient care beginning at the pediatric age, diabetic patients may develop some complications during their lifetime . One of these complications is limited joint mobility (LJM) that has been defined as the reduction of joint range of motion (ROM), usually associated with stiffness, which can affect the joints of the whole body in patients with diabetes at different ages …”

Section: Introductionmentioning

confidence: 99%

Type 1 diabetes, sport practiced, and ankle joint mobility in young patients: What is the relationship?

Francia

Toni

Iannone³

et al. 2018

Pediatr Diabetes

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Background/Objective It is known that patients with diabetes can develop limited joint mobility (LJM) and that this can depend on the metabolic control maintained and the duration of the disease. The aims of this study were to verify the presence of ankle joint mobility (AJM) deficits in both plantar and dorsiflexion in young type 1 diabetic patients (T1D) considering also the possible role of sport practiced as a further factor, able to modify AJM. Methods AJM was evaluated by an inclinometer in 82 T1D patients (M/F: 48/34), mean age 12.9 ± 2.6 years, body mass index (BMI) 19.7 ± 3.6 kg/m2, duration of diabetes 5.6 ± 3.3 years, mean HbA1c 7.5 ± 1.0% and in 226 healthy controls (M/F: 146/80), age‐, gender‐, and BMI‐matched practicing different sports (soccer, volleyball, basketball, and dance). Results The patients’ ankle range of motion was significantly lower than that in controls (132.7 ± 22.3° vs 126.1 ± 17.9°; P < .017). In particular, ankle plantar flexion was significantly lower in the patients group (31.6° ± 7.9° vs 28.5° ± 6.6°; P < .002). Soccer players showed lower AJM in both groups: patients (120.1 ± 15.9° vs 127.3 ± 18.1) and controls (119.4 ± 21.1° vs 142.0 ± 18.1; P < .0001) than subjects practicing other sports or who were sedentary. In both groups, patients and controls, age, sex, duration of disease, hemoglobin 1Ac, and BMI have not been shown to be correlated to the mobility assessed. Conclusions The results of this study, in addition to confirming the negative effect of diabetes on AJM of young T1D patients, suggest that during these evaluations the sport‐related effect should be considered because it can induce significant changes of AJM.

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Connective tissue disorders in diabetes

Cited by 5 publications

References 61 publications

Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices

Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices

Limited Joint Mobility in Childhood Diabetes: Discovery, Description, and Decline

Type 1 diabetes, sport practiced, and ankle joint mobility in young patients: What is the relationship?

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