Rheumatic Manifestations of Endocrine Diseases

Carpal Tunnel Syndrome

Idiopathic in over 50% of cases of Carpal tunnel syndrome (CTS) is associated with diabetes (present in 25% of cases), RA, hypothyroidism, CPPD, acromegaly, and multiple myeloma.^[58,59]

Hand involvement in diabetes mellitus is common (seen in over 30% of patients) presenting in several different forms (Trigger fingers, Dupuytren's contracture,^[60] reflex sympathetic dystrophy, stiff hand syndrome and or flexor tenosynovitis). Occurring more often with increased duration of disease it is often predictive of renal, retinal and other complications of diabetes mellitus. Diabetic stiff hand syndrome (diabetic cheirarthropathy) - another fibrosing syndrome often looking like scleroderma - results in contractures at the metacarpophalageal and PIP joints.^[61,62]

Trigger fingers are the result of flexor tenosynovitis which causes proliferation of fibrous tissue in the tendon especially when the tendon passes through the fibrous ring or pulley. DeQuervain syndrome involves the same process at the radial styloid with thickening of the extensor pollicis brevis or the adductor pollicis longus tendon. This type of tendinitis occurs in RA, myxedema, and trauma as well as in 30% of patients with diabetes mellitus.^[63]

Dupuytren's contracture (palmer thickening of the flexor tendons) has been initially reported in 15–21% of diabetic patients.^[64,65] A recent article^[66••] reported positive result with injections of collegenase clostridium histolytic for the treatment of Dupuytren's contracture.

Osteoporosis: Diabetes mellitus is thought to impact on quality of bone. Studies have demonstrated decreased bone density and increased bone marrow fat as well as reduced new bone formation.^[67]

Curr Opin Rheumatol. 2010;22(1):64-71. © 2010  Lippincott Williams & Wilkins

Cite this: Rheumatic Manifestations of Endocrine Diseases - Medscape - Jan 01, 2010.