Exclusive: ACR Convergence 2024| Focus Rheums

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Rheumatic Manifestations of Diabetes (Mimics, Common Culprits & More)

Michael J. Cammarata, MD  |  Issue: November 2024  |  

Conclusion

The intersection of diabetes mellitus and rheumatic diseases presents a unique set of challenges for both diagnosis and management. The non-inflammatory rheumatic manifestations of diabetes, including diabetic cheiroarthropathy, scleredema and diabetic myonecrosis, can mimic rheumatic conditions and lead to significant functional impairment. Awareness and understanding of these manifestations are crucial for accurate diagnosis and to avoid unnecessary immunosuppression.

Likewise, carpal tunnel syndrome, Dupuytren’s contracture and trigger finger are common among patients with diabetes. By recognizing and addressing these musculoskeletal complications, providers can enhance the overall quality of life for patients with diabetes.

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Michael J. Cammarata, MD, is an assistant professor of medicine at the Johns Hopkins School of Medicine, Baltimore.

References

  1. National Diabetes Statistics Report. Centers for Disease Control and Prevention. 2024 May 15. https://www.cdc.gov/diabetes/php/dataresearch/index.html.
  2. Hill NE, Roscoe D, Stacey MJ, Chew S. Cheiroarthropathy and tendinopathy in diabetes. Diabet Med. 2019 Aug;36(8):939–947.
  3. Larkin ME, Barnie A, Braffett BH, et al. Musculoskeletal complications in type 1 diabetes. Diabetes Care. 2014 Jul; 37(7):1863–1869.
  4. American Diabetes Association Professional Practice Committee. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes–2024. Diabetes Care. 2024 Jan;47(Suppl1):S52–S76.
  5. Kapoor A, Sibbitt WL Jr. Contractures in diabetes mellitus: The syndrome of limited joint mobility. Semin Arthritis Rheum. 1989 Feb; 18(3):168–180.
  6. Nashel J, Steen V. Scleroderma mimics. Curr Rheumatol Rep. 2012;14(1):39–46.
  7. Lieberman LS, Rosenbloom AL, Riley WJ, et al. Reduced skin thickness with pump administration of insulin. N Engl J Med. 1980 Oct;303(16):940–941.
  8. Morgan ND, Hummers LK. Scleroderma mimickers. Curr Treatm Opt Rheumatol. 2016 Mar;2(1):69–84.
  9. Trujillo-Santos AJ. Diabetic muscle infarction: An underdiagnosed complication of longstanding diabetes. Diabetes Care. 2003 Jan; 26(1):211–215.
  10. Horton WB, Taylor JS, Ragland TJ, et al. Diabetic muscle infarction: A systematic review. BMJ Open Diabetes Res Care. 2015 Apr;3(1):e000082.
  11. Sureja NP, Devarasetti PK, Rajasekhar L. Diabetic myonecrosis: An unusual mimicker of idiopathic inflammatory myositis. J R Coll Physicians Edinb. 2020 Jun;50(2):148–151.
  12. Burner TW, Rosenthal AK. Diabetes and rheumatic diseases. Curr Opin Rheumatol. 2009 Jan;21(1):50–54.
  13. Sanjari E, Raeisi Shahraki H, G Khachatryan L, et al. Investigating the association between diabetes and carpal tunnel syndrome: A systematic review and meta-analysis approach. PLoS One. 2024 Apr;19(4):e0299442.
  14. Gamstedt A, Holm-Glad J, Ohlson CG, et al. Hand abnormalities are strongly associated with the duration of diabetes mellitus. J Intern Med. 1993 Aug;234(2):189–193.
  15. Monjed A. Diabetes and Rheumatology. In: Skills in Rheumatology. Singapore: Springer;2021. https://www.ncbi.nlm.nih.gov/books/NBK585735.
  16. Zimmerman M, Dahlin E, Thomsen NOB, et al. Outcome after carpal tunnel release: Impact of factors related to metabolic syndrome. J Plast Surg Hand Surg. 2017 Jun;51(3):165–171.
  17. Knoedler TG, Gaertner AP, Wilkinson PJ, et al. Incidence, prevalence, and outcomes of hand manifestations in patients with diabetes mellitus: A comprehensive literature review. Hand (N Y). 2024 Jan 30;15589447231219522.
  18. Chammas M, Bousquet P, Renard E, et al. Dupuytren’s disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. J Hand Surg Am. 1995 Jan;20(1):109–114.
  19. Räisänen MP, Leppänen OV, Soikkeli J, et al. Surgery, needle fasciotomy, or collagenase injection for dupuytren contracture: A randomized controlled trial. Ann Intern Med. 2024 Mar;177(3):280–290.
  20. Makkouk AH, Oetgen ME, Swigart CR, et al. Trigger finger: Etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008 Jun;1(2):92–96.
  21. Moore JS. Flexor tendon entrapment of the digits (trigger finger and trigger thumb). J Occup Environ Med. 2000 May;42(5):526–545.
  22. Csonka V, Varjú C, Lendvay M. Diabetes mellitus-related musculoskeletal disorders: Unveiling the cluster of diseases. Prim Care Diabetes. 2023 Dec;17(6):548–553.

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