title: Correlation of Systemic Inflammatory Markers With Radiographic Stages of Charcot Osteoarthropathy.
abstract: BACKGROUND
  Charcot osteoarthropathy (COA) is characterized by a progressive destruction of bone and joint associated with neuropathy and is most common in the foot and ankle. Clinical manifestation of COA is frequently indistinguishable from other causes of pain, swelling, and erythema of the affected extremity, in particular, infection. Diagnosis of COA can be challenging in particular in early stages where radiographic changes are sparse. The presence of elevated systemic inflammatory parameters in the context of suspected infection may delay early diagnosis and treatment of COA. The aim of this retrospective analysis was to assess whether elevated systemic inflammatory parameters may be present, in particular in early stages of COA and thus not be used as an exclusion criterion for the diagnosis of COA.
  
  
  METHODS
  Forty-two patients (mean age 48.2 ± 9.4 years, 36 male, 6 female) with a diagnosis of unilateral COA were the subject of this retrospective study. The diagnosis of COA was confirmed by plain radiographs, magnetic resonance imaging and clinical course. Systemic inflammatory parameters were recorded at the time of referral. Acute stages (stages 0 and 1) were treated with a total contact cast (TCC) and protected weight bearing for a minimum of 6 weeks. For chronic stages (stages 2 and 3) custom-made shoes were prescribed. The feet were stratified into "acute" (Eichenholz stages 0 and 1) and "subacute/chronic" (Eichenholz stages 2 and 3) groups.
  
  
  RESULTS
  Statistically significant differences were observed for all recorded systemic inflammatory parameters (C-reactive protein level, WBC count, erythrocyte sedimentation rate) between the acute and subacute/chronic groups. No statistical difference was observed considering the anatomic pattern of involvement.
  
  
  CONCLUSIONS
  The present study demonstrated that elevated systemic inflammatory parameters may be present in COA and can further be used to distinguish between acute and subacute stages of COA, based on the Eichenholtz classification. Thus, we suggest that elevated inflammatory markers should not be considered an exclusion criterion for the diagnosis of COA.
  
  
  METHODS
  Level III, retrospective comparative series.
authors.affiliation: Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland a.hingsammer@gmail.com.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Hingsammer
authors.affiliation: Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Bauer
authors.affiliation: Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland.
authors.forename: Niklas
authors.initials: N
authors.lastname: Renner
authors.affiliation: Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Borbas
authors.affiliation: Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Boeni
authors.affiliation: Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Berli
mesh_terms: D001177:Arthropathy, Neurogenic / Q000150:complications / Q000473:pathology*; D015415:Biomarkers; D002097:C-Reactive Protein / Q000737:chemistry / Q000502:physiology; D006801:Humans; D007592:Joint Diseases / Q000503:physiopathology*; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000473:pathology*; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: C-reactive protein; CRP; Charcot osteoarthropathy; diagnosis; systemic inflammatory markers