Prevalence Of Limited Joint Mobility Research Articles

Differences and Similarities in the Feet of Metatarsalgia Patients with and without Rheumatoid Arthritis in Remission.

Objectives: Metatarsalgia continues to be a problem in patients with rheumatoid arthritis (RA) in remission (remRA), as well as in the non-rheumatic population, with a mechanical origin. Identify and compare clinical, morphological, disability, synovitis (ultrasound), and radiological osteoarticular damage characteristics in two groups of patients with lesser-ray metar-tarsalgia, with remRA, and without RA. Methods: Cross-sectional study with 84 patients with remRA (mRA) and 60 patients without RA (nmRA). The study evaluated five clinical variables (pain, Foot Function Index (FFI), joint mobility, digital deformities, and foot type), a radiological variable (osteoarticular damage), and an ultrasound variable (metatarsal synovitis). The data were analysed using descriptive and correlational techniques. Results: There were no significant differences in sex, age, body mass index (BMI), or degree of pain. Both groups showed a high prevalence of limited joint mobility for the ankle and first metatarsal phalanx (DF1st MTPJ) and digital deformities, with no statistically significant differences. Similarly, there were no differences in lesser-ray synovitis. On the other hand, there were differences in mRA with greater disability and activity limitation (FFI), LDD (lesser-ray digital deformities) stiffness, first-ray deformities, radiological damage, synovitis in 1st MTPJ, and positive Doppler (five patients). Conclusions: Metatarsalgia presents similarities in both populations. Biomechanical factors may influence the symptoms and presence of synovitis in patients with RA in remission. Other characteristics are more frequent in mRA, which could be related to the disease; thus, future research should include both biomechanical and ultrasound exploration of the foot in the valuation of patients in remission.

Diabetic hand syndromes as a clinical and diagnostic tool for diabetes mellitus patients

Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia with various complications including diabetic hand syndrome (DHS); a condition characterized by association of distinct entities; limited joint mobility (LJM), Dupuytren's disease (DD), flexor tenosynovitis (FTS) and carpal tunnel syndrome (CTS) resulting in significant morbidity and mortality. The aim of this study was to evaluate the prevalence of these changes and their association to diabetes duration. We studied 142 type 2 and 45 type 1 DM patients and investigated the presence of these hand changes and peripheral neuropathy (PNP). The prevalence of LJM was 29.4%, DD was 17.6%, FTS was 10.7% and CTS 41.7% in all diabetics. The prevalence of CTS was more in type 2 DM (83.3%) as compared to type 1 DM (24.4%). Age and duration of diabetes were clearly related to these changes. A clear association between these changes and PNP was observed. The prevalence of CTS and hand changes was higher in type 2 diabetics. The association of DD and PNP suggests that common factors could contribute to their pathogenesis. Consequently, clinical examination for diabetic hand should not ignore it.

Reduced Prevalence of Limited Joint Mobility in Type 1 Diabetes in a U.K. Clinic Population Over a 20-Year Period

Limited joint mobility (LJM), one of the earliest clinically apparent long-term complications of type 1 diabetes, is a risk marker for subsequent microvascular complications. We hypothesize that the prevalence of LJM may have decreased during the past two decades due to improved standards of glycemic control. A single observer performed a survey in 204 consecutive patients with type 1 diabetes (106 men and 98 women, age 27 +/- 1 years, HbA(1c) 8.3 +/- 0.1%, duration of diabetes 14.5 +/- 0.8 years, insulin dose 63 +/- 2 units/day). We used the same examination method and criteria for assessment of LJM as used by us in an earlier study in 1981-1982. The prevalence of LJM has fallen from 43 to 23% between the 1980s and 2002 (P < 0.0001). The relative risk for LJM in 2002 compared with the 1981-1982 cohort was 0.53 (0.40 < RR < 0.72, P < 0.0001). The prevalence of LJM was increased with longer duration of diabetes (<10 years, 13%; 10-20 years, 19%; 20-29 years, 30%; >30 years, 65%; P < 0.001). The relative risk for those with a mean HbA(1c) <7% in 2002 was 0.3 (0.1 < RR < 1.2, P = 0.05) when compared with those with mean HbA(1c) >7%. The present study confirms the hypothesis that the prevalence of LJM is lower than 20 years ago and that improved standards of glycemic control and diabetes care may have contributed to this occurrence. Joint limitation in type 1 diabetes is strongly associated with duration of diabetes. The presence of LJM remains a common and important clinical marker for subsequent microvascular disease and can be a useful clinical tool for identification of patients at increased risk.

Changes in frequency and severity of limited joint mobility in children with type 1 diabetes mellitus between 1976-78 and 1998

Objective: Limited joint mobility (LJM), the earliest clinically apparent long-term complication of type 1 diabetes mellitus, is a risk indicator for microvascular complications, and its appearance is primarily affected by long-term metabolic control. We hypothesized that the prevalence of LJM had decreased during the past 20 years. Study design: We examined 312 subjects with type 1 diabetes mellitus, aged 7 to 18 years, using the same examination method and criteria as in studies of 515 subjects in this age group carried out between 1976 and 1978 for whom primary data were available, including age, duration of diabetes, and LJM stage. Statistical analyses included exact χ2 tests, independent sample t tests, and unconditional logistic regression. Results: There was a >4-fold reduction in frequency of LJM between 1976-78 and 1998 (31% vs 7%, P <.001), with a decrease in the proportion having moderate or severe LJM (35% vs 9%, P =.025). Conclusions: These findings confirm the hypothesis that the prevalence of LJM has decreased, most likely the result of improved blood glucose control during the past 2 decades. (J Pediatr 2001;138:33-7)

Limited joint mobility in Sri Lankan patients with non-insulin-dependent diabetes.

Two hundred and sixteen patients with non-insulin-dependent diabetes (NIDDM) and 216 age- and gender-matched controls were studied to assess the prevalence of limited joint mobility (LJM). Joint mobility was measured by goniometry at metacarpophalangeal and subtalar joints, and those in whom a prayer sign was elicited were said to have cheiroarthropathy. Forty diabetic patients and 10 controls had cheirorathropathy. The mean range of motion was reduced at metacarpophalangeal joints in diabetic patients with cheiroarthropathy (36.8 +/- 9.2) and without cheiroarthropathy (45.7 +/- 8.1) when compared to controls (51.4 +/- 9, P < 0.01). Mobility at subtalar joints was reduced in those with cheiroarthropathy (25 +/- 5.3, P < 0.01) when compared to controls (32.4 +/- 4.1) and diabetic patients without cheiroarthropathy (27.4 +/- 4.6). No differences in subtalar mobility existed between diabetic patients without cheiroarthropathy and controls. Significant differences were observed in the presence of foot ulceration (35 vs 16%) in those with and without cheiroarthropathy. We conclude that cheiroarthropathy is seen in Sri Lankan patients with NIDDM and that significant limitation of joint mobility is present in patients with NIDDM who do not have overt cheiroarthropathy and that overt cheiroarthropathy may be a marker for a high risk of foot ulceration.

Limited joint mobility is associated with the presence but does not predict the development of microvascular complications in type 1 diabetes.

Previous cross-sectional studies have shown that limited joint mobility (LJM) is associated with microvascular complications in diabetic patients. This study was performed to see whether LJM predicts the development of other diabetic complications and which factors predispose to the development of LJM. A total of 206 Type 1 diabetic patients (mean age 30.0 +/- 9.5 (SD) years) was studied at baseline. The follow-up study was performed 5 years later in 167 of 206 (81.1%) patients. At the baseline the presence of LJM was assessed by asking patients to approximate the palmar surfaces of fingers in a praying position with fingers fanned and the wrists maximally flexed. LJM was confirmed by passive extension. At the follow-up LJM was first reassessed by the same method and then further studied by goniometer and classified by the method of Rosenbloom. The diabetic patients were assessed in terms of the following complications: background and proliferative retinopathy, peripheral symmetrical polyneuropathy, and clinical nephropathy. The prevalence of LJM was 52.9% at baseline. The odds ratio for proliferative retinopathy was 3.3 (95% confidence interval 1.2-9.5) and for neuropathy 2.5 (95% confidence interval 1.2-5.3) in diabetic patients with LJM compared to patients without LJM, when the confounding effect of the duration of diabetes, age and the body mass index was excluded. LJM developed in 30 patients during the 5-year follow-up (7% per year) and its development was not predicted by any of the microvascular complications at baseline. Proliferative retinopathy developed in 4 of 51 (7.8%) patients with and 3 of 63 (4.8%) patients without LJM at baseline (p = 0.3). Nephropathy developed in 11 of 56 (19.6%) patients with and 11 of 66 (16.7%) patients without LJM at baseline (p = 0.7) and peripheral symmetrical neuropathy in 14 of 45 (31.1%) and 20 of 64 (31.3%) patients respectively (p = 1.0). LJM did not predict diabetic microvascular complications or vice versa. Since LJM is associated with microvascular complications in cross-sectional studies, the clinical value of the assessment of LJM is limited to an orienteering examination in the clinical evaluation of a diabetic patient.

Risk factors for expression and progression of limited joint mobility in insulin-dependent childhood diabetes.

We studied the prevalence of limited joint mobility (LJM) in 100 diabetic children and 100 non-diabetic controls. Our objective was to find possible predictors for the expression and progression of LJM and to evaluate the relationship between LJM and other long-term complications of insulin-dependent diabetes mellitus. LJM was present in 36% of diabetic patients aged 2-20 years. It was significantly related to duration of disease and longitudinal glycated haemoglobin (HbA1c) concentrations, pubertal stage, number of ketoacidosis and skin changes. Fourteen patients had peripheral neuropathy, 16 had microalbuminuria, 8 had nephropathy, and 7 had retinopathy. After matching for duration of disease, HbA1c concentrations and pubertal stage, a comparison of the complication rates was made. All long-term complications were significantly associated with LJM. Longer duration of disease and higher mean longitudinal glycated haemoglobin level are independent predictors for expression of LJM. Thus, improvement of metabolic control in diabetic patients before puberty may diminish the expression and progression of LJM.

Limited Joint Mobility and Lipodystrophy in Children and Adolescents with Insulin‐Dependent Diabetes Mellitus

One hundred forty-eight children, aged 11.9 +/- 3.7 years, who had insulin-dependent diabetes mellitus (IDDM) for 4.5 +/- 3.7 years and glycosylated Hb values (HbA1) of 10.5% +/- 4.5%, were examined for limited joint mobility (LJM) and lipodystrophy. In all diabetics, human biosynthetic insulin was used. Six hundred forty-eight pupils, aged 11.8 +/- 2.5 years, served as controls. LJM was found in 28.4% of the diabetics and in 7.5% of the controls (p < 0.001). The presence and severity of LJM was positively correlated with the duration of diabetes and negatively with height. There was no correlation between the presence of LJM and sex, chronological age, age of diabetes onset, HbA1 values, or retinopathy. Lipodystrophy at insulin injection sites was found in 37.1% of the diabetics. Hypertrophic lesions predominated. Our findings and those of the literature lead to the following conclusions: the prevalence of LJM in IDDM subjects of comparable age using Rosenbloom's criteria is almost uniform in all published studies (28%); the correlation, however, of prevalence and severity to different parameters presents discrepancies which cannot be interpreted at present. Human biosynthetic insulin does not protect from lipodystrophy and alterations of insulin injections still remain the only currently available preventive and therapeutic measure.

Limited joint mobility in children and adolescents with insulin dependent diabetes mellitus.

Joint mobility was studied in 70 children with insulin dependent diabetes mellitus aged 8-17 years, and the prevalence of limited joint mobility (LJM) was found to be 31% (22/70). This figure fell to only 7% (5/70) when an alternative method of assessment was used. A high number of non-diabetic, non-sibling controls (6/51 (12%] were found to have LJM. There was a trend towards an increasing prevalence of LJM with increasing age and duration of diabetes, but it was also found in patients with recent onset diabetes. A large proportion of prepubertal patients were noted to have LJM. No correlation was found between LJM and either short stature or diabetic control. There is a need for standardisation of the methods used to define and stage LJM in diabetic patients, and the significance of this clinical finding remains unclear.

Cheiroarthropathy and long term diabetic complications in Nigerians.

Two hundred and fifty six consecutively ambulant diabetic patients attending a Nigerian diabetic clinic for the presence of cheiroarthropathy were examined using standard criteria. Forty eight (19%) had limited joint mobility of the hand, a prevalence higher than the 4% (2/56) observed in a non-diabetic population matched for age and sex. Limited joint mobility was twice as prevalent in the insulin treated (16/50, 32%) than in the non-insulin dependent (32/206, 16%) diabetics. Indices such as age, duration of diabetes, and glycaemic control (as assessed by integrated blood glucose concentration over the previous 12 months and glycated haemoglobin (HbA1c concentrations) were the same in the diabetics with and without limited joint mobility. The prevalence of cataracts (18/48, 38%) and background retinopathy (8/48, 17%) was higher in diabetics with limited joint mobility than in those without (respectively 6-9% and 5-6%); hypertension, peripheral neuropathy, and foot ulcers, however, were about equally common in the two groups of diabetics (with and without limited joint mobility). Nephropathy appeared commoner in diabetic subjects without limited joint mobility. Our results confirm previous observations in Caucasians of an increased prevalence of limited joint mobility in diabetes, especially those receiving insulin treatment, and also showed that limited joint mobility could predict the presence of retinopathy and cataracts in those diabetics. Neuropathy and hypertension were not commoner in our diabetics with limited joint mobility (unlike in the Caucasian population), suggesting that racial factors may underlie the predictive value of limited joint mobility in diabetic microangiopathy.

Hand Abnormalities are Associated with the Complications of Diabetes in Type 2 Diabetes

Limited finger joint mobility, Dupuytren's contracture, and the complications of diabetes were assessed in 233 Type 2 diabetic patients. Limited joint mobility was present in 34% and Dupytren's contracture in 26%. The prevalence of limited joint mobility and Dupuytren's contracture increased with duration of diabetes and with age. Logistic regression analysis showed that, after allowing for age and duration of diabetes, limited joint mobility was independently associated with Dupuytren's contracture (odds ratio 5.7, 95% CI 2.0-16.4) and retinopathy (odds ratio 3.1, CI 1.5-6.4). Dupuytren's contracture was independently associated with vision-threatening retinopathy (odds ratio 2.6, CI 1.1-6.4), limited joint mobility (odds ratio 2.5, CI 1.3-4.8), and foot ulceration (odds ratio 4.9, CI 1.4-16.4). Both Dupuytren's contracture and limited joint mobility were associated with peripheral neuropathy but neither hand abnormality was associated with neuropathy independently of other complications of diabetes. The association of connective tissue abnormalities in the hand with the complications of diabetes suggests that similar factors may be contributing to their pathogenesis.

Limited finger joint mobility in insulin-dependent and non-insulin-dependent Ethiopian diabetics.

The prevalence of limited joint mobility (LJM) was studied in 110 insulin-dependent (IDDM) and 190 non-insulin-dependent (NIDDM) consecutive Ethiopian African diabetics and 300 age- and sex-matched controls at the Tikur Anbassa Teaching Hospital in Addis Ababa over a period of 18 months. Mean ages +/- S.D. of the IDDM, NIDDM, and controls were 35 +/- 9.9, 49.4 +/- 12.0, and 43.3 +/- 14.0 years, respectively. LJM was found in 44.5% of IDDM, 25.3% of NIDDM, and 6.7% of controls, being significantly commoner in IDDM than NIDDM (p less than 0.001) and in the diabetics than in controls (p less than 0.001). In IDDM those with LJM were significantly younger (p less than 0.05), had a higher prevalence of median fasting blood glucose (FBG) levels of 15 mmol/l and above (p less than 0.01), and retinopathy (p less than 0.05), but did not differ from those without LJM in duration of diabetes, or prevalence of neuropathy and nephropathy. In NIDDM those with LJM had a significantly longer duration of diabetes (p less than 0.005) and a higher prevalence of nephropathy (p less than 0.005), but did not differ from those without LJM in age at onset of diabetes, prevalence of neuropathy, and retinopathy or median FBG level.

Limited joint mobility of the hand in type I diabetes mellitus.

Limited joint mobility (LJM) of the hand was present in 32 of 100 subjects, aged 3-22 yr, with type I diabetes mellitus. Prevalence of LJM was independent of age and sex, but increased with duration of diabetes, with peak occurrence in individuals who had diabetes for more than 5 yr (P less than 0.005). In age-and duration-matched pairs of control and LJM subjects (N = 31), there was no significant correlation of LJM with insulin type, insulin allergy, family history of arthritis, or growth retardation. There was also no correlation with "control parameters" including number of episodes of hypoglycemia and ketoacidosis, degree of ketonuria or mean glucose, hemoglobin A1, fasting triglyceride, or cholesterol value.