Why has this 31-year-old man gradually developed significant stiffness in his joints, which is now preventing him from clenching his fists or squatting? That’s what Yafang Zhou, MD, PhD, of Xiangya Hospital in Hunan, China, and colleagues wanted to figure out.
As they reported in JAMA Neurology, the man’s experience began about 6 months previously, when he found he could not press his palms into full contact with each other (the “prayer sign”).
This continued to worsen, so that 4 months later he had become unable to clench his fists. When he presented to the clinic for an assessment, he explained that he was also no longer able to squat as of about 10 days earlier.
Neither his medical nor family history offered clues as to what might be causing the progressive joint stiffness. He had no symptoms that would suggest Raynaud’s phenomenon, such as cold fingers or toes, or changes in skin color, pain, or numbness in response to cold or stress.
Physical examination revealed no superficial changes such as reddened or hardened areas of skin on his arms, legs, or trunk, or evidence of swelling. He had limited mobility of the joints in his hands, wrist, feet, and ankles. There was no evidence of muscular atrophy or sclerodactyly. Clinicians observed the “prayer sign” — often due to diabetic cheiroarthropathy — and a linear depression along the course of the superficial vein known as the “groove sign” when the patient’s arm was elevated.
Blood test results indicated eosinophilia:
- Absolute eosinophil count: 1,300 μL; (reference
- Erythrocyt