title: Charcot arthropathy presenting with primary bone resorption.
abstract: BACKGROUND
  The clinical presentation of acute Charcot arthropathy in the diabetic population usually follows the Eichenholtz classification. We present three usual cases of Charcot arthropathy presenting with rapid primary bone resorption in the absence of subluxation, dislocation and/or fracture.
  
  
  METHODS
  A review of the literature was performed. To our knowledge Charcot arthropathy has not been previously described as primary bone resorption.
  
  
  METHODS
  Three cases encountered at our specialist multidisciplinary High Risk Foot Clinic (HRFC) presented with primary bony resorption without features of subluxation, dislocation and/or fracture.
  
  
  CONCLUSIONS
  Aggressive primary bone resorption was initially thought due to infection; a diagnostic dilemma that delayed optimal treatment. Late bone resorption in typical Charcot is linked to unregulated proinflammatory cytokines (IL-1β, IL-6 and TNFα) that lead to increased osteoclastic activity. The pathophysiology of osteolysis in aggressive primary bony resorption may relate to a disturbance in the balance between RANK-L and OPG.
  
  
  CONCLUSIONS
  Primary resorption of bone without subluxation, dislocation and/or fracture can represent an active Charcot process. Prudent use of serial radiography and early MRI to look for the widespread bone and soft tissue oedema is recommended.
authors: Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia. cjon0040@gmail.com
authors: Christopher W
authors: CW
authors: Jones
authors: David
authors: D
authors: Agolley
authors: Kharis
authors: K
authors: Burns
authors: Sanjeev
authors: S
authors: Gupta
authors: Mark
authors: M
authors: Horsley
mesh_terms: D001177:Arthropathy, Neurogenic / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D001862:Bone Resorption / Q000503:physiopathology*; D002370:Casts, Surgical; D003937:Diagnosis, Differential; D005260:Female; D033023:Foot Joints / Q000503:physiopathology*; D061826:Foot Orthoses; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis; D012881:Skin Temperature