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Endocrine disorders commonly cause musculoskeletal symptoms and may even present with rheumatic syndromes before the nature of the underlying endocrinopathy is apparent (Table 55–1). On occasion, endocrine disorders can mimic rheumatic diseases and be a source of diagnostic error (Table 55–2). Rheumatic manifestations of endocrine diseases are usually a consequence of the hormonal abnormalities but, in the case of autoimmune thyroid disease, also can be a result of the underlying autoimmune process.

Table 55–1. Rheumatic Manifestations Associated with Endocrine Disorders.
Table 55–2. Early Manifestations of Endocrine Disorders that Can Mimic Rheumatic Diseases.

Patients with either type 1 or type 2 diabetes mellitus frequently have musculoskeletal complaints. Although relatively little is understood about the pathophysiological effects of hyperglycemia on bones, joints, tendons, and muscles, there are well-established associations between diabetes and certain musculoskeletal syndromes (Table 55–3).

Table 55–3. Rheumatic Manifestations of Diabetes.

Diabetic Cheiropathy (Limited Joint Mobility Syndrome)

Essentials of Diagnosis

  • Most commonly seen in hands.
  • Limited flexion and extension of finger joints.
  • Skin becomes progressively puffy and appears shiny and waxy.
  • “Prayer sign” is simple diagnostic maneuver.

General Considerations

Diabetic cheiropathy, or limited joint mobility syndrome, usually develops after 10 or more years of diabetes (type 1 or 2), particularly when glycemic control has been suboptimal, and likely is due to abnormal glycosylation of connective tissues. Although most frequently recognized and encountered in the hands, this condition can involve the shoulders, knees, and feet.

Clinical Findings & Treatment

The limited mobility results from a generalized palmar fasciitis and from progressive thickening ...

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