Joint contractures have recently been recognized as part of the clinical spectrum of insulindependent diabetes mellitus (1). Waxy, thickened skin over the dorsum of the fingers and nonfamilial short stature may accompany these contractures (1,2). Contractures preceding the onset of diabetes have not been reported.
We report a child who had progressive, multiple joint contractures for 3 years before his diabetes was manifested. His joint range of motion improved when insulin therapy was instituted.
Case report. This 16-year-old white boy began to experience transitory morning stiffness in his metacarpophalangeal and proximal interphalangeal joints and in his wrists at the age of 12. During the next 4 years, the stiffness became more prolonged and progressed to include his knees, ankles, hips, elbows, shoulders, and neck. At no time was any joint swollen or warm. He gradually lost significant range of motion in all the above joints and in his distal interphalangeal joints and the metatarsophalangeal joints. His hands were most severely affected and very tight, contracted flexor tendons could be palpated in his palms. There was no family history of diabetes or rheumatic disease.
From the Division of Pediatric Rheumatology and the