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      The onset of acute Charcot neuroarthropathy during pregnancy in patients with type 1 diabetes

      research-article
      Author(s): 1 , 3 , 1 , 4 , 2 , 3
      Publication date (Electronic):
      Journal: Endocrinology, Diabetes & Metabolism Case Reports
      Publisher: Bioscientifica Ltd
      Keywords: Adult, Female, White, France, Bone, Bone, Insulin, Diabetes mellitus type 1, Diabetic nephropathy, Diabetic neuropathy*, Charcot neuroarthropathy*, Hyperglycaemia, Thyroiditis, Diabetes mellitus type 1, Diabetic neuropathy, Charcot neuroarthropathy*, Hyperglycaemia, Microalbuminuria, Oedema, Feet - increased size, Retinopathy, Paraesthesia, Diabetic nephropathy, Vomiting, Haemoglobin A1c, Ultrasound scan, Albumin, Monofilament test*, Iron supplements, Insulin, Vitamin supplements*, Corticosteroids, Prednisone, Podiatry, Insight into disease pathogenesis or mechanism of therapy, July, 2020

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          Abstract

          Summary

          We report the onset of acute Charcot neuroarthropathy during pregnancy in two patients with type 1 diabetes using retrospective review of case notes. We describe for the first time the onset of acute Charcot neuroarthropathy during pregnancy in two patients with type 1 diabetes. Pregnancy may promote the onset and worsening of a number of diabetic complications. A link between pregnancy and the onset of acute Charcot neuroarthropathy is demonstrated for the first time in this report.

          Learning points:

          • Patients with already diagnosed sensitive neuropathy can develop an active phase of Charcot neuroarthropathy during pregnancy.

          • The rapid correction of hyperglycaemia may induce an active phase of Charcot neuroarthropathy during pregnancy.

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          Most cited references8

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          The Charcot foot: pathophysiology, diagnosis and classification.

          K Trieb (2016)
          Neuropathic changes in the foot are common with a prevalence of approximately 1%. The diagnosis of neuropathic arthropathy is often delayed in diabetic patients with harmful consequences including amputation. The appropriate diagnosis and treatment can avoid an extensive programme of treatment with significant morbidity for the patient, high costs and delayed surgery. The pathogenesis of a Charcot foot involves repetitive micro-trauma in a foot with impaired sensation and neurovascular changes caused by pathological innervation of the blood vessels. In most cases, changes are due to a combination of both pathophysiological factors. The Charcot foot is triggered by a combination of mechanical, vascular and biological factors which can lead to late diagnosis and incorrect treatment and eventually to destruction of the foot. This review aims to raise awareness of the diagnosis of the Charcot foot (diabetic neuropathic osteoarthropathy and the differential diagnosis, erysipelas, peripheral arterial occlusive disease) and describe the ways in which the diagnosis may be made. The clinical diagnostic pathways based on different classifications are presented. Cite this article: Bone Joint J 2016;98-B:1155-9.
          Article 0 comments Cited 34 times – based on 0 reviews     Review now
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            Impact of pregnancy on the progression of diabetic retinopathy in Type 1 diabetes.

            P Heyburn, Shirlene M. Sampson, Tiffany Greenwood … (2001)
            To evaluate the impact of pregnancy on the progression of diabetic retinopathy in women with Type 1 diabetes mellitus and to identify risk factors for the progression of retinopathy during pregnancy. One hundred and seventy-nine pregnancies in 139 women with pregestational Type 1 diabetes were studied prospectively between January 1990 and December 1998. Dilated fundal examination was performed at booking, 24 weeks and 34 weeks or 4-6 weekly if retinopathy present at booking. Data were collected on glycaemic control (HbA(1c)) throughout pregnancy. Progression to proliferative retinopathy was seen in four (2.2%) pregnancies while moderate progression was seen in a further five (2.8%) pregnancies. Progression of retinopathy was significantly increased in women with duration of diabetes 10-19 years compared with duration 10 years and in women with moderate to severe retinopathy at baseline. Laser therapy was needed in 2.2% pregnancies, which is much lower than that reported in earlier studies. Diabet. Med. 18, 573-577 (2001)
            Article 0 comments Cited 26 times – based on 0 reviews     Review now
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              Neuro-arthropathy (Charcot joints) in diabetes mellitus (clinical study of 101 cases).

              Leslie P. Kozak, S Sinha, C Munichoodappa (1972)
              Article 0 comments Cited 22 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endocrinol Diabetes Metab Case Rep
                Journal ID (iso-abbrev): Endocrinol Diabetes Metab Case Rep
                Journal ID (hwp): EDM
                Title: Endocrinology, Diabetes & Metabolism Case Reports
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2052-0573
                Publication date (Electronic): 15 July 2020
                Publication date Collection: 2020
                Volume: 2020
                Electronic Location Identifier: 20-0002
                Affiliations
                [1 ]Diabetology Department , Centre Hopitalier Sud Francilien, Corbeil-Essonnes, France
                [2 ]Diabetology Department , AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
                [3 ]Sorbonne Université , Paris, France
                [4 ]Paris-Sud Medical School , Paris-Saclay University, Orsay, France
                Author notes
                Correspondence should be addressed to D Dardari; Email: dured.dardari@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-7172-4300
                Article
                Publisher ID: EDM200002
                DOI: 10.1530/EDM-20-0002
                PMC ID: 7424321
                PubMed ID: 32669476
                SO-VID: 521aafbf-3929-4731-be00-68fb7cb8e047
                Copyright © © 2020 The authors
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License..

                History
                Date received : 18 April 2020
                Date accepted : 26 May 2020
                Categories
                Subject: Adult
                Subject: Female
                Subject: White
                Subject: France
                Subject: Bone
                Subject: Bone
                Subject: Insulin
                Subject: Diabetes Mellitus Type 1
                Subject: Diabetic Nephropathy
                Subject: Diabetic Neuropathy*
                Subject: Charcot Neuroarthropathy*
                Subject: Hyperglycaemia
                Subject: Thyroiditis
                Subject: Diabetes mellitus type 1
                Subject: Diabetic neuropathy
                Subject: Charcot neuroarthropathy*
                Subject: Hyperglycaemia
                Subject: Microalbuminuria
                Subject: Oedema
                Subject: Feet - increased size
                Subject: Retinopathy
                Subject: Paraesthesia
                Subject: Diabetic nephropathy
                Subject: Vomiting
                Subject: Haemoglobin A1c
                Subject: Ultrasound scan
                Subject: Albumin
                Subject: Monofilament test*
                Subject: Iron supplements
                Subject: Insulin
                Subject: Vitamin supplements*
                Subject: Corticosteroids
                Subject: Prednisone
                Subject: Podiatry
                Subject: Insight into Disease Pathogenesis or Mechanism of Therapy
                Subject: Insight into Disease Pathogenesis or Mechanism of Therapy

                Keywords: adult,female,white,france,bone,insulin,diabetes mellitus type 1,diabetic nephropathy,diabetic neuropathy*,charcot neuroarthropathy*,hyperglycaemia,thyroiditis,diabetic neuropathy,microalbuminuria,oedema,feet - increased size,retinopathy,paraesthesia,vomiting,haemoglobin a1c,ultrasound scan,albumin,monofilament test*,iron supplements,vitamin supplements*,corticosteroids,prednisone,podiatry,insight into disease pathogenesis or mechanism of therapy,july,2020
                Data availability:
                Keywords: adult, female, white, france, bone, insulin, diabetes mellitus type 1, diabetic nephropathy, diabetic neuropathy*, charcot neuroarthropathy*, hyperglycaemia, thyroiditis, diabetic neuropathy, microalbuminuria, oedema, feet - increased size, retinopathy, paraesthesia, vomiting, haemoglobin a1c, ultrasound scan, albumin, monofilament test*, iron supplements, vitamin supplements*, corticosteroids, prednisone, podiatry, insight into disease pathogenesis or mechanism of therapy, july, 2020

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