Diagnosis of Acute and Subacute Charcot´s Osteoarthropathy in Diabetics

Overview

Charcot´s osteoarthropathy (CHOA) is a progressive destructive disease of bones and joints of the foot in patients suffering from neuropathy, most frequently of diabetic origin. Its diagnosis is controversial in particular because this diagnosis is not taken into account and is confounded with other diseases, in particular osteomyelitis, arthritis, osteoporosis etc. The objective of the present work was to draw attention, based on the authors own experience, to pitfalls associated with the basic diagnosis of CHOA in particular on the basis of the case-history, physical, neurological and X-ray examination. In a group of 18 diabetic patients (10 with DM type 1, 8 with DM type 2, mean duration of DM 15 ± 7 years, mean age 52 ± 14 years) suffering from CHOA in the acute or subacute stage the diagnosis was established on the basis of the physical finding of oedema of the foot and elevated skin temperature and a positive finding of diabetic peripheral and autonomous neuropathy. Laboratory tests ruled out other causes of inflamma- tory or metabolic disease of tissues of the foot. Concurrent X-ray changes of the foot were found in 17 of 18 subjects, however only in five patients these X-ray changes were evaluated as typical CHOA. In the case-history of diabetics with CHOA frequently also other complications of DM were found, in particular nephropathies (in 17 subjects) and retinopathies (in 16 subjects). In patients with CHOA there was surprisingly a relative frequent finding of positive angiography - ischaemia of the lower extremities (in 5 subjects of 8 indicated examinations). In the diagnosis of CHOA among other methods isotope scintigraphy of the skeleton proved useful. The most important factor for better diagnosis of acute and subacute CHOA is to make doctors aware of this diagnosis in patients with a typical case-history (prolonged DN, severe neuropathy) and a physical finding (unilateral oedema of the foot with elevated skin temperature, sometimes deformities and usually a not quite unequivocal X-ray finding of the foot), eliminating other aetiologies, in particular on the basis of laboratory tests. Only in this way it is possible to start effective treatment which will prevent the development of permanent deformities and chronic ulceration’s or the necessity of amputation.

Key words:
diabetes mellitus - diabetic foot - Charcot´s osteoarthropathy.