EARLY DETECTION OF LIMITED JOINT MOBILITY IN CHILDREN AND ADOLESCENTS WITH INSULIN-DEPENDENT DIABETES

Limited joint mobility (LJM) is a common complication of juvenile diabetes, usually assessed by a clinical method, the prayer test. Recently, the interest of the use of a goniometer in measuring subclinical joint limitation has been shown in adult diabetic patients. Joint mobility has been systematically assessed with a goniometer in 58 consecutive diabetic children (mean age = 12.8 yrs, mean duration of diabetes = 3,6 yrs) and compared to 119 normal children, for elbows, wrists, metocarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of the 5th finger, in order to detect subclinical anomalies, The results showed a significant loss of the MCP flexion and extension, of the PIP flexion and of the DIP extension in diabetic children when the values were analysed according to the physiological variation with age. The prayer test detected LJM in three patients only. The degrees of elbow and DIP extension, and wrist flexion, decrease when the duration of diabetes increases, independently of the age. Anomalies of the 5th finger joint mobility were found to be correlated with microvascular anomalies of retinal angiography and nailfold capillaroscopy. However, no correlation was found with the measure of HbA1c performed at the time of the joint assessment. The measure of joint mobility with a goniometer has detected a decrease of finger mobility in diabetic children, early in the course of diabetes. These preliminary data should be confirmed in a longitudinal study that will be performed in a larger setting, in order to propose diagnostic criteria of infraclinical diagnosis of LJM.