Pathophysiology: thickening of the collagen in the skin and periarticular tissues, which makes it more stiff
Clinical features:
(1) limited joint mobility, particularly in the small joints of the fingers
(1a) bilateral and symmetrical
(1b) The limited joint mobility results in flexion contractions.
(1c) The patient is unable to place the fingers and palm flat on a surface. The "prayer sign" describes the inability to approximate the 2 palms placed opposite to each other with the fingers fanned out.
(2) thickening and stiffness of the skin, which feels "waxy"
(3) otherwise asymptomatic, without pain
Risk factors:
(1) Many patients are pediatric insulin-dependent diabetics.
(2) The role of poor glycemic control is controversial, but many patients have a high percent of glycated hemoglobin.
