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© 1989 British Society for Rheumatology

research-article

SKIN BLOOD FLOW AND LIMITED JOINT MOBILITY IN INSULIN-DEPENDENT DIABETES MELLITUS

W. S. MITCHELL*,, P. H. WINOCOUR{dagger}, R. J. GUSH*, L. J. TAYLOR*, R. D. BAKER{ddagger}, D. C. ANDERSON{dagger} and M. I. V. JAYSON*

*University of Manchester, Rheumatic Diseases Centre Salford University Salford
{dagger}University of Manchester, Department of Medicine, Hope Hospital Eccles Old Road
{ddagger}University of Manchester, Computing Service Section, Salford University Salford

Correspondence to: Correspondence to Dr. Mitchell.

Hand skin blood flow in 32 insulin-dependent (IDDM) diabetics was compared with 13 healthy controls at room temperature and after immersion of the hands in warm and cold water. Subjects were examined for limited joint mobility (LJM) to analyse the association between this and blood flow. Digital arteries remained patent in IDDM compared to controls after cold challenge (p=0.0001), and the difference persisted to a lesser degree 15 min (p=0.009) and 30 min (p=0.03) after recovery. Capillary blood flow was reduced in IDDM at room temperature at the finger nailbeds (p<0.02) and the palms (p=0.004) and remained so after warm water immersion in the palms (p=0.002), where further vasoconstriction was observed immediately after cold water immersion (p<0.001) and 15 and 30 min into recovery (p=0.07 and p=0.009 respectively). Thermographic analysis confirmed a pattern of predominantly distal rewarming after cold challenge in IDDM with a greater mean index finger temperature than the controls. Together, these features suggested enhanced arteriovenous anastomotic blood flow.

All IDDM and IDDM males with LJM had reduced palm capillary flow immediately after cold challenge (p<0.05). After warm water (p<0.03) and 30 min after cold challenge (p<0.05) IDDM males with LJM had reduced palm capillary flow compared to those IDDM without.

A microvascular aetiology for LJM is proposed by virtue of reduced nutritional blood flow and evidence of enhanced arteriovenous shunting in the hands of insulin-dependent diabetics.

KEY WORDS: Skin blood flow, Insulin-dependent diabetes, Limited joint mobility, Laser doppler flowmetry, Thermal challenge


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