Gout as a trigger for acute Charcot neuro-osteoarthropathy?
Keywords:Charcot neuro-osteoarthropathy, diabetes, foot, gout, infection, antibiotics
AbstractPatients with diabetes and a painful, hot, swollen foot can sometimes present a diagnostic challenge. Gout can often present in a similar fashion to diabetic foot infections or acute Charcot neuro-osteoarthropathy, and cases have been described where patients with Charcot neuro-osteoarthropathy were misdiagnosed as having gout, leading to treatment delay. We describe a patient who presented with a painful, swollen, warm foot who did not respond to initial treatment with antibiotics. Improvement in his symptoms occurred following treatment for gout, however he then went on to develop Charcot neuro-osteoarthropathy. As far as we are aware, this is the first case described in the literature where acute gout may have triggered acute Charcot neuro-osteoarthropathy. It is important to bear in mind that more than one pathology may be present in a patient at the same time or may closely follow one another.
Choi HK, Mount DB, Reginato AM. Pathogenesis of gout. Ann Intern Med 2005;143:499–516. https://doi.org/10.7326/0003-4819-143-7-200510040-00009
Chen LX, Schumacher HR. Current trends in crystal identification. Curr Opin Rheumatol 2006;18:171–3. https://doi.org/10.1097/01.bor.0000209430.59226.0f
Singh JA, Reddy SG, Kundukulam J. Risk factors for gout and prevention: a systematic review of the literature. Curr Opin Rheumatol 2011;23:192–202. https://doi.org/10.1097/BOR.0b013e3283438e13
Roddy E, Zhang W, Doherty M. The changing epidemiology of gout. Nat Clin Pract Rheumol 2007;3:443–9. https://doi.org/10.1038/ncprheum0556
Rodriguez G, Soriano L, Choi H. Impact of diabetes against the future risk of developing gout. Ann Rheum Dis 2010;69:2090–4. https://doi.org/10.1136/ard.2010.130013
Pakarinen TK, Laine HJ, Honkonen SE, et al. Charcot arthropathy of the diabetic foot. Current concepts and review of 36 cases. Scand J Surg 2002;91:195–201. https://doi.org/10.1177/145749690209100212
Gill GV, Hayat H, Majid S. Diagnostic delays in diabetic Charcot arthropathy. Pract Diabetes 2004;21:261–2. https://doi.org/10.1002/pdi.677
Baglioni P, Malik M, Okosieme OE. Acute Charcot foot. BMJ 2012; 344:e1397. https://doi.org/10.1136/bmj.e1397
Frykberg RG, Kozak GP. Neuropathic arthropathy in the diabetic foot. Am Fam Physician 1978;17:105–13.
Rogers LC, Frykberg RG, Armstrong DG, et al. The Charcot foot in diabetes. Diabetes Care 2011;34:2123–9. https://doi.org/10.2337/dc11-0844
Jeffcoate WJ, Game F, Cavanagh PR. The role of proinflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes. Lancet 2005;366:2058–61. https://doi.org/10.1016/S0140-6736(05)67029-8
Petrova NL, Moniz C, Elias DA, et al. Is there a systemic inflammatory response in the acute Charcot foot? Diabetes Care 2007;30:997–8.
Kaynak G, Birsel O, Güven MF, Öğüt T. An overview of Charcot foot pathophysiology. Diabetic Foot Ankle 2013;4:21117. https://doi.org/10.3402/dfa.v4i0.21117
Barksfield R, Gallagher K, Pasapula C. Silent gout: an unusual presentation in diabetic neuropathy. Foot (Edinb) 2012;22:264–6. https://doi.org/10.1016/j.foot.2012.06.002
Crasto W, Jogia R, Jackson S, et al. Ulcerated gout masquerading as a non healing diabetic foot ulcer: a case series. Br J Diabetes Vasc Dis 2014;14:21–5. https://doi.org/10.15277/bjdvd.2014.004
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