Diabetes

Question 1

Diabetic arthropathies?

Answer 1

Gout - Weak but real association

CPPD

Neuropathic

Degenerative

DISH (weak association)

Septic/osteomyelitis

Soft tissue: Periarthritis, Diabetic Cheiroarthropathy

Question 2

What is Periarthritis?

Answer 2

Painfull, stiff shoulder with limimted ROM wiout evidence of intra-articular disease.

MC: Women over 40

More common in non-dominant shoulder

When associated with diabetes (4-5x higher incidence) more often bilateral, and predominates in insulin-dependent DM of long duration

Associated with CRPS

Question 3

What is Diabetic Cheiroarthropathy?

Answer 3

Up to 40% of insulin-dependent juvenile diabetics

Mild to moderate joint contractures of the fingers

predominantly PIP and 4th and 5th digits

Thick and waxy appearance of skin on dorsum of hand

short stature

Occasional involvement of wrists, elbows, hips, knees and toes

Resembles scleroderma

Question 4

Dupuytren’s and Diabetes?

Answer 4

3-40% have diabetes (probably closer to 40)

More common involvement of 3rd digit more common in diabetics

more common with long-standing disease

worse in men, but usally mild overall

Question 5

Flexor tenosynovitis and diabetes?

Answer 5

10-30% with flexor tenosynovitis are diabetic

Marked female predominance

More common in R hand

Question 6

Complicating/aggravating factors of neuroarthropathy in diabetes?

Answer 6

Ischemia, trauma, infection

Question 7

Distribution of neuroarthropahty in diabetes?

Answer 7

MC: T-MT, Intertarsal, MT-P

Ankle and interphalangeal are less frequent

Lisfrac fracture-dislocation simulating or could be presenting feature

Question 8

Osteopenia and diabetes?

Answer 8

MC in insulin-treated DM (~50%), and more significant in whites and females

Question 9

Part of arterial vessel that is calcified in diabetes?

Answer 9

Media (instead of intima)

Question 10

Clinical features of lipoatrophic diabetes?

Answer 10

Insulin-resistant diabetes

hepatosplenomegaly

hyperlipidemia, hypermetabolism

accelerated growth and maturation

muscular overdevelopment, hirsutism, hyperpigmentation

progressive loss of adipose tissue without ketosis

(also cutaneous xanthomas, protuberant abdomen, corneal opacities, mental retardation)

Question 11

Radiographic features of lipoatrophic diabetes?

(Beradinelli-Seip syndrome)

Answer 11

Decrease or absence of body fat (loss of soft tissue planes)

Markedly advanced bone age in children

Thickening of diaphyseal cortices, metaphyseal sclerosis, hypertrophy of epiphyses

Small cystic lesions may appear in metaphysis

Question 12

MC congenital anomalies of infants of diabetic mothers?

Answer 12

Sacrococcygeal agenesis (caudal regression syndrome)

Visceromegally with increased body fat

(16% of children born to diabetic mothers have sacral anomalies)

Other: meningocele, hip dislocations, flexion contractures of knees and hips, foot deformities, urinary tract anomalies

Unsusual facies, femoral hypoplasia