Compelling work from our friends Nina Petrova, Mike Edmonds, et al at King’s College, London.
Inflammatory and bone turnover markers in a cross-sectional and prospective study of acute Charcot osteoarthropathy
N. L. Petrova1,*, T. K. Dew2, R. L. Musto2, R. A. Sherwood2, M. Bates1, C. F. Moniz2 andM. E. Edmonds1
Aims
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, high-sensitivity 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 high-sensitivity 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.
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