Diabetic cheiroarthropathy in uncontrolled Type 2 diabetes with positive Anti-Nuclear Antibodies: a case report from Sudan

Abstract

Diabetic cheiroarthropathy, also known as limited joint mobility, is one of the long-standing complications of type 2 Diabetes Mellitus (DM). It affects 8-50% of patients with type 1 diabetes and is also seen in type 2 diabetic patients. Consequently, it can mimic many rheumatological diseases and is often underdiagnosed. We present a case of a long-standing poorly controlled diabetes with diabetic cheiroarthropathy and diabetic neuropathy, along with positive ANA in the absence of any correlated autoimmune or rheumatological diseases. A 52-year-old female patient with poorly controlled diabetes (her last HbA1c reading was 9.5%) presented to Rheumatology clinic with flexion deformities of the fingers. The patient has impaired vibration, two-point discrimination and pinprick sensation in gloves and stock distribution, indicating peripheral neuropathy, entrapment neuropathy in the forms of bilateral carpal tunnel syndrome, and the diagnosis of diabetic cheiroarthropathy was made. Additionally, she has a positive prayer sign and tabletop sign. Despite the absence of symptoms and signs of autoimmune disorders, this patient has positive antinuclear antibodies global (ANA positive by Indirect Immuno-Fluorescence (IIF) 1\320 nucleolar pattern) with a negative: ANA profile, rheumatoid factor (RF) and Anticyclic Citrullinated Peptide Antibody (ACPA). Regular and careful hands examination should be part of clinical assessment for diabetic patients as it could be a very simple and useful screening tool for diabetic cheiroarthropathy. Physicians can use this condition as a mirror for microvascular complications of diabetes. This allows for early detection and appropriate interventions to prevent further progression of diabetes-related complications. It is also essential to consider the presence of positive ANA in diabetic cheiroarthropathy despite the absence of any rheumatological and autoimmune diseases.