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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2014 September;173(9):485-7
Non-inflammatory painful knee joints swelling with limited mobility in type 1 diabetes mellitus, a saudi female patient
Almarzouki A. A.
Unit of Endocrinology, Department of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
A 17 years old type 1 Diabetes Mellitus (DM) vitally stable female presented to the diabetic center of Alnoor Specialist Hospital, Makkah, Saudi Arabia on 4th of December 2012, to optimize her blood glucose levels. Her chief complaints were bilateral knee joints moderate painful swelling with mild tenderness and limited joint mobility (LJM) without active signs of inflammation. Glycated hemogloblin (HbA1c) was 13.8% and workup for arthritis was negative. Other etiologies of LJM were excluded, i.e., systemic lupus erythematosus, rheumatoid arthritis, Gout, and hypothyroidism. New insulin regimen was initiated, i.e., long acting (NPH) twice and short acting regular insulin (HR) three times a day. She was discharged, re-examined in OPD after six weeks and found clinically improved, having pain scale about 3/10 on comparative pain scale with no tenderness and swelling on knee joints. HbA1c was found 11% and 10.3% on the 3rd OPD visit after three weeks of the 2nd visit. Metabolic control, patient’s education, and regular follow up by endocrinologist should be emphasized. Large joints’ examination with standard joint’s mobility measurements by rheumatologist should be a part of routine examination of DM patients.