The pathogenesis of Charcot neuroarthropathy: current concepts

Larson, Shelly A. M.; Burns, Patrick R.

doi:10.3402/dfa.v3i0.12236

Cited by 39 publications

(19 citation statements)

References 13 publications

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“…The literature pertaining to Charcot arthropathy has acknowledged this lack of validation, citing the subjectivity of the classification's stages and the difficulties encountered when attempting to distinguish the end of one stage and the beginning of the next as impediments to proper validation [6]. There are other challenges that complicate validation, including the limited prevalence of Charcot arthropathy, which is reported to be 0.08% to 7.5% in patients with diabetes, the high frequency of delayed and missed diagnoses, and the multitude of joints affected [14,15]. Additionally, validation requires assessment of each patient's imaging and physical examination findings by multiple observers at one time, and with time, which can be difficult to facilitate.…”

Section: Validationmentioning

confidence: 99%

Classifications in Brief: Eichenholtz Classification of Charcot Arthropathy

Rosenbaum

DiPreta

2015

Clinical Orthopaedics &Amp; Related Research

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Section: Validationmentioning

confidence: 99%

Classifications in Brief: Eichenholtz Classification of Charcot Arthropathy

Rosenbaum

DiPreta

2015

Clinical Orthopaedics &Amp; Related Research

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“…Proposed mechanisms via somatic and autonomic neuropathy, loss of neurogenic control of bone remodelling, increased osteoclast activity, osteolysis and progressive degeneration (Larson and Burns, )…”

Section: Unwanted Side Effectsmentioning

confidence: 99%

Therapeutic Review of Methylprednisolone Acetate Intra‐Articular Injection in the Management of Osteoarthritis of the Knee – Part 2: Clinical and Procedural Considerations

McCrum

2016

Musculoskeletal Care

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The use of an intra-articular methylprednisolone acetate (MPA) injection has been shown to have benefits for symptoms of knee osteoarthritis (OA). However, considerations beyond drug efficacy can influence the appropriateness, clinical effectiveness and potential harm of an injection. A review of research evidence and published literature on clinical and procedural factors influencing the effectiveness and safety of a knee injection has been undertaken. Factors include dose, frequency, contraindications, precautions, drug interactions, side-effects, and procedural and patient-related considerations. An evaluation of evidence indicated that a 40 mg dose provides clinical benefit. No strong predictors of response were evident, with the exception of pain severity. Additional benefit for outcomes from higher doses, local anaesthetic, ultrasound guidance or particular anatomical approaches is yet to be demonstrated. Evidence for dose- and duration-related detrimental effects suggests judicious use and frequency. The evaluation showed that there are a number of contraindications and precautions arising from the drug pharmacology, concurrent medications, comorbidities and adverse events which need consideration and monitoring. There was limited safety evidence concerning anticoagulation. The review found that specialist guidance and limited evidence suggests that injection safety concerning warfarin may be enhanced by ensuring that the international normalized ratio level is within therapeutic range. However, the risk-benefit evaluation concerning non vitamin K antagonist oral anticoagulants remains challenging. Although there is published guidance, a lack of clinical studies, safety evidence and reversibility advocates caution. Overall, the review indicates that injection decisions and procedures need an individualized approach and supporting evidence is limited in many areas. Evaluation and discussion of benefits and risks, peri-procedural and post-injection management, and tailoring to the context and individuals' preferences are important in optimizing the benefits and safety of a knee injection.

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“…In addition to this, monocytes obtained from Charcot patients present reduced secretion of anti-inflammatory cytokines, and increased resistance to apoptosis (21, 42). This resistance provided mainly by IL-1β and TNFα causes the persistence of the abnormally intense and prolonged inflammatory response (3). Ndip et al reported that IL-8 and Granulocyte-Colony Stimulating Factor (GCSF) were inducing monocytes into an osteoclastic differentiation along with the RANKL/RANK pathway (41).…”

Section: Pathophysiologymentioning

confidence: 99%

“…A variety of causes are held responsible for triggering, amplifying, and converting the inflammatory processes which appears to be the major suspect at hand (3). Firm evidence was set forth that proinflammatory cytokines, especially the receptor activator of the nuclear factor-κB (RANK) ligand (RANKL) system is responsible for abnormally intense osteoclastogenesis (4).…”

mentioning

confidence: 99%

“…Addressing this rarity, Jeffcoate explains that Charcot arthropathy develops or progresses in a small subset of patients where a number of predisposing factors coexist (26). The prevalence of diagnosed Charcot arthropathy in patients with diabetes is reported to be 0.08–7.5% (3). However, some studies suggest higher prevalence with as many as 13% of all diabetic patients and 29% of the neuropathic patients affected (22, 27).…”

mentioning

confidence: 99%

See 1 more Smart Citation

An overview of the Charcot foot pathophysiology

Kaynak¹,

Birsel²,

Güven³

et al. 2013

Diabetic Foot & Ankle

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Charcot arthropathy of the foot is a rare but devastating complication of diabetes that remains to be a challenging issue for the foot and ankle surgeons. Charcot foot fails to be an obvious diagnostic option that comes to mind, even in a pathognomonic clinical appearance. The rarity of the disorder, more common pathologies that mimic the condition, and the self-limiting prognosis deviate the clinician from the right diagnosis. The clinical challenges in the diagnosis of Charcot foot require in-depth investigations of its enigmatic nature to establish useful guidelines. Yet, this goal seems to be beyond reach, without a holistic view of the immense literature concerning the pathophysiology of the disorder. The primary objective of this article is to put together and review the recent advancements about the etiology and intrinsic mechanisms of diabetic Charcot foot.

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The pathogenesis of Charcot neuroarthropathy: current concepts

Cited by 39 publications

References 13 publications

Classifications in Brief: Eichenholtz Classification of Charcot Arthropathy

Classifications in Brief: Eichenholtz Classification of Charcot Arthropathy

Therapeutic Review of Methylprednisolone Acetate Intra‐Articular Injection in the Management of Osteoarthritis of the Knee – Part 2: Clinical and Procedural Considerations

An overview of the Charcot foot pathophysiology

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