From Adelaide, SA, Australia:
I am sixteen and have had diabetes for 11 years and have recently been diagnosed with diabetic cheiroarthropathy and diabetic stiff hands. No one I ask seems to have much information on this condition; could you please help me?
Type 1A or autoimmune diabetes, which is the kind of diabetes that you almost certainly have, results when a small group of white blood cells called lymphocytes become wrongly progammed so that instead of eliminating bacteria and other foreign proteins they come to perceive certain specific body cells as targets. In the case of this kind of diabetes, these are the insulin-producing cells in the pancreas. Usually one specific type of cell is the main target in these conditions; but in the last few years it has come to be recognised that in some people with Type 1 diabetes other systems may be involved in the autoimmune process.
This is especially true of the thyroid; but much more rarely may involve the intestine causing the coeliac syndrome or the suprarenal (adrenal) glands caausing Addison's disease. There are other targets too, such as the lining cells of the stoamach which may lead to pernicious anemia.
Finally, there are a variety of disorders of connective tissue that are significantly associated with both Type 1 and Type 2 forms. These affect the flexor tendons of the fingers as in cheiroarthropathy, or 'the 'stiff hand syndrome', produce a thickening of the skin as in scleroderma and sometimes a much more extensive involvement of muscles as well as connective tissue as in the 'stiff man syndrome'. Where this occurs in autoimmune Type 1A Diabetes this complication has been thought of as yet another related condition, an idea that has sometimes been confirmed by finding anti GAD (glutamic acid decarboxylase) antibodies in the blood.
However since most cases occur in Type 2 Diabetes, the alternative hypothesis is that these changes are linked to thickening of the lining of the related small blood vessels. About twenty years ago the earliest signs of stiffening of the flexor tendons in the little finger were used as a rudimentary measure of control and still poor control is supposed to have a role.
There is a lot more to say and you can find some of it in Children with Diabetes by searching under 'stiff hand syndrome' and you can find even more with the same search in PubMed. If you are near a medical library, you might like to look at one paper by Collier,A. and others in Diabetes Care, Volume 12, page 309 (1986, I think!).
Original posting 29 Dec 1998
Posted to Complications
Last Updated: Tuesday April 06, 2010 15:09:02
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