title: Inflammatory and bone turnover markers in a cross-sectional and prospective study of acute Charcot osteoarthropathy.
abstract: OBJECTIVE
  To assess markers of inflammation and bone turnover at presentation and at resolution of Charcot osteoarthropathy.
  
  
  METHODS
  We measured serum inflammatory and bone turnover markers in a cross-sectional study of 35 people with Charcot osteoarthropathy, together with 34 people with diabetes and 12 people without diabetes. In addition, a prospective study of the subjects with Charcot osteoarthropathy was conducted until clinical resolution.
  
  
  RESULTS
  At presentation, C-reactive protein (P = 0.007), tumour necrosis factor-α (P = 0.010) and interleukin-6 (P = 0.002), but not interleukin-1β, (P = 0.254) were significantly higher in people with Charcot osteoarthropathy than in people with and without diabetes. Serum C-terminal telopeptide (P = 0.004), bone alkaline phosphatase (P = 0.006) and osteoprotegerin (P < 0.001), but not tartrate-resistant acid phosphatase (P = 0.126) and soluble receptor activator of nuclear factor-κβ ligand (P = 0.915), were significantly higher in people with Charcot osteoarthropathy than in people with and without diabetes. At follow-up it was found that tumour necrosis factor-α (P = 0.012) and interleukin-6 (P = 0.003), but not C-reactive protein (P = 0.101), interleukin-1β (P = 0.457), C-terminal telopeptide (P = 0.743), bone alkaline phosphatase (P = 0.193), tartrate-resistant acid phosphatase (P = 0.856), osteoprotegerin (P = 0.372) or soluble receptor activator of nuclear factor-kβ ligand (P = 0.889), had significantly decreased between presentation and the 3 months of casting therapy time point, and all analytes remained unchanged from 3 months of casting therapy until resolution. In people with Charcot osteoarthropathy, there was a positive correlation between interleukin-6 and C-terminal telopeptide (P = 0.028) and tumour necrosis factor-α and C-terminal telopeptide (P = 0.013) only at presentation.
  
  
  CONCLUSIONS
  At the onset of acute Charcot foot, serum concentrations of tumour necrosis factor-α and interleukin-6 were elevated; however, there was a significant reduction in these markers at resolution and these markers may be useful in the assessment of disease activity.
authors.affiliation: Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: N L
authors.initials: NL
authors.lastname: Petrova
authors.forename: T K
authors.initials: TK
authors.lastname: Dew
authors.forename: R L
authors.initials: RL
authors.lastname: Musto
authors.forename: R A
authors.initials: RA
authors.lastname: Sherwood
authors.forename: M
authors.initials: M
authors.lastname: Bates
authors.forename: C F
authors.initials: CF
authors.lastname: Moniz
authors.forename: M E
authors.initials: ME
authors.lastname: Edmonds
mesh_terms: D000328:Adult; D000368:Aged; D001177:Arthropathy, Neurogenic / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D001862:Bone Resorption / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D024042:Collagen Type I / Q000097:blood*; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D015536:Down-Regulation; D006801:Humans; D007103:Immobilization; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood*; D008137:Longitudinal Studies; D008875:Middle Aged; D010455:Peptides / Q000097:blood*; D011446:Prospective Studies; D012074:Remission Induction; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide