AB0924 Charcot Arthropathy: A Diagnostic Challenge in Diabetic Patients. Clinical Features of 21 Cases

Abstract

Background Charcot arthropathy is a destructive arthropathy with severe bone resorption that occurs in patients with sensory neuropathy of any etiology. This arthropathy can be a diagnostic challenge, because it has little clinical expression and requires to be suspected by specialists not used to assess patients with joint pathology. Objectives To analyze the clinical features of patients with Charcot arthropathy diagnosed in our department in the last years. Methods We systematically reviewed cases with Charcot arthropathy diagnosed in our department in the last 12 years (2002-2013). Demographics, underlying disease, time since onset of the arthropathy, clinical characteristics and referral department were collected. Results 21 cases of Charcot arthropathy (57% male), age 55.8 years (29-78) were confirmed. The underlying disease was 15 diabetes, 2 syringomyelia, 2 leprosy 1 Charcot-Marie-Tooth, and 1 idiopathic sensory autonomic polyneuropathy. Patients with diabetes had a disease of 13.5 years of evolution (range 1-25). Of these patients 73% had peripheral vascular disease and 93% almost had one cardiovascular risk factor. The patients came mainly from Endocrinology (34%). Other referral departments were: Emergency (16%), Vascular Surgery (14%), Podiatry (14%), Internal Medicine (9%), Neurology (5%) and Orthopaedics (5%). We observed a delayed diagnosis of the arthropathy, with a mean of 360 days (4-1500). The most common form of clinical presentation was: swelling (57%), mild pain (52%), deformity (38%), fracture (1 patient). In 1 patient the diagnosis was casual (radiological finding). Most patients (57%) had a trigger: local infection (58%), surgery (25%) or injury (17%). The most common site in patients with diabetes was the tarsus (87%). Conclusions Charcot arthropathy is mostly seen in patients with long-standing diabetes with peripheral vascular disease associated with other cardiovascular risk factors. Patients come mostly from Endocrinology, and although half of the patients had a trigger there is a clear diagnostic delay. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4001

Charcot, the Man, the Joint and its Care

“…There are various definitions of Charcot joint; Rathur and Boulton [11], defines it as "... a non infective arthropathy in a wellperfused insensitive foot". Casado et al [12], on the other hand defines it as "... destructive arthropathy with severe bone resorption that occurs in patients with sensory neuropathy of any aetiology".…”