Acute Neuropathic Joint Disease

Acute Neuropathic Joint Disease: A Medical Emergency?

“…Offloading results in protection of the bones and joints of the foot, as well as amelioration of the underlying inflammatory process. W e thank Jeffcoate et al (1) for their comments on our article (2). To summarize, they agree that neuropathic joint disease (NJD) is indeed a medical emergency, but they disagree that bisphosphonates are of proven efficacy.…”

“…R eading the exchange of letters in the December 2005 issue regarding the management of inpatient hyperglycemia made me reflect on personal experiences as a hospital patient (1,2). In past years, as surgeons and cardiologists tended to their more immediate tasks, my diabetes was often relegated to a secondary and sometimes seemingly nonexistent concern.…”

Expression of the receptor activator of nuclear factor-kB ligand in peripheral blood mononuclear cells in patients with acute Charcot neuroarthropathy

“…This disease can lead to a severe amputation of feet: in such cases, osteomyelitis has been described as trigger mechanisms of developing CN, thus an effective antibiotic therapy could have a positive role in the course of the disease. CN is early characterised by acute inflammation that may cause osteopenia, bone resorption and bone weakening which subsequently may lead to chronic bone alterations such as fractures, dislocations, instability and gross deformities 1-3. Indeed, local inflammation is associated with the release of proinflammatory cytokines such as interleukin (IL)-1alpha and tumor necrosis factor (TNF)-alpha, which are known mediators of bone resorption via excess osteoclastic activity 4,5.…”

Conservative and surgical treatment of the chronic Charcot foot and ankle

“…This subsequent deformity in the presence of peripheral neuropathy greatly increases the risk of skin ulceration and lower limb amputation (10–12). CN is a medical emergency, because if it is diagnosed earlier, the treatment can prevent the destructive process (9, 10, 13). …”

“…On the other hand, the neurotraumatic theory suggests that CN is an overuse injury in which insensate joints are subjected to either repetitive microtrauma or single traumatic event that leads to typical Charcot changes (1, 2, 10, 12). Lack of protective sensation delays the recognition of bone injuries that may overload the insensate limb and leads to an active Charcot process (13–15). Sensation loss prevents the affected individual from adopting normal protective mechanisms, specifically offloading and activity modification, and from seeking medical attention (1, 13–15).…”