Impaired microcirculation in Charcots neuroarthropathy

NewsBot · Aug 6, 2015

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In diabetic Charcot neuroarthropathy impaired microvascular function is related to long lasting metabolic control and low grade inflammatory process
Aleksandra Araszkiewicz, , Jacek Soska, Katarzyna Borucka, Marta Olszewska, Pawel Niedzwiecki, Bogna Wierusz-Wysocka, Dorota Zozulinska-Ziolkiewicz
Microvascular Research; Volume 101, September 2015, Pages 143?147

Highlights
?Deterioration of microvascular function is present in Charcot neuroarthropathy.
?Impaired microvascular reactivity is associated with higher skin autofluorescence.
?Impaired microvascular reactivity is associated with low grade inflammatory process.
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Aims
The aim of this study was to assess microvascular function associated with the occurrence of Charcot neuroarthropathy (CN) in patients with diabetes.

Methods
We evaluated 70 diabetic patients (54 men) with Charcot neuroarthropathy (CN-DM), median age 59 (IQR: 51?62), mean disease duration 16 ? 8 years. The control group were 70 subjects with diabetes and without Charcot neuroarthropathy (DM), 54 men, median age 60 (54?62), mean diabetes duration 15 ? 7 years. We assessed metabolic control of diabetes, serum C-reactive protein concentration (CRP) and cardiovascular autonomic neuropathy (CAN). We used AGE-Reader to measure skin autofluorescence (AF) associated with accumulation of advanced glycation end products that reflects long lasting metabolic control. Microvascular function was examined by laser Doppler flowmetry (PERIFLUX 5000) with thermal hyperemia (TH) and postocclusive reactive hyperemia (PORH).

Results
CN-DM patients as compared to DM subjects had lower HbA1c level [7.6 (6.6?8.4) vs 8.4 (7.3?9.7)%, p < 0.001], lower eGFR [75.9 ? 24.1 vs 86.6 ? 17.8 ml/min/1.73 m2, p = 0.003], higher CRP serum concentration [3.8 (2.3?10.1) vs 1.9 (0.8?4.4)mg/l, p < 0.001] and higher skin autofluorescence [2.8 (2.5?3.1) vs 2.6 (2.3?2.9)AU, p = 0.03]. The cardiovascular autonomic neuropathy (CAN) was more frequently diagnosed in CN-DM subjects [59 vs 27%, p < 0.001]. The peak flow during thermal hyperemia (THmax) was lower in CN-DM subjects as compared to DM group [156 (93?240) vs 235 (155?300)PU, p = 0.001]. We found negative correlation between THmax and CRP concentration (Rs = − 0.34, p = 0.003), TG concentration (Rs = − 0.37, p = 0.002) and skin AF (Rs = − 0.32, p = 0.04) and positive correlation between THmax and HDL cholesterol level (Rs = 0.42, p < 0.001) in CN-DM patients. There was also a positive correlation between PORHpeak and HDL cholesterol level (Rs = − 0.23, p = 0.04).

Conclusion
Deterioration of microvascular function and autonomic system dysfunction are present in Charcot neuroarthropathy. Impaired microvascular reactivity is associated with worse long lasting metabolic control of diabetes and low grade inflammatory process.
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Admin2 · Aug 6, 2015

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NewsBot · Jul 10, 2018

From Podiatry Today:
Is Blood Flow A Significant Factor In Patients With Charcot Neuroarthropathy?

NewsBot · Mar 18, 2022

Cutaneous microvascular reactivity in Charcot neuroarthropathy: a systematic review and meta-analysis
Sean Michael Lanting, Tsz Long Chan, Sarah Louise Casey, Benjamin John Peterson & Vivienne Helaine Chuter
Journal of Foot and Ankle Research volume 15, Article number: 17 (2022)

Background
To systematically evaluate the literature investigating the relationship between cutaneous microvascular reactivity in the foot of adults with diabetes-related Charcot neuroarthropathy compared to a non-Charcot adult control group.

Methods
A systematic search was conducted to June 2021 using the biomedical databases EBSCO Megafile Ultimate, Cochrane Library and EMBASE. Original research conducting comparative investigation of cutaneous microvascular reactivity in the foot of adults with diabetes and any pattern of acute or chronic Charcot neuroarthropathy and any non-Charcot adult control groups were included. A modified Critical Appraisal Skills Programme tool was used for quality appraisal. Cutaneous microvascular reactivity in diabetes-related Charcot neuroarthropathy data were synthesised and meta-analysis conducted where possible.

Results
The search strategy identified 1,684 articles, with seven eligible for inclusion. Included studies used various methodologies and equipment to assess cutaneous microvascular reactivity in 553 participants (162 with Charcot neuroarthropathy). Cutaneous microvascular reactivity in Charcot neuroarthropathy groups was impaired compared to uncomplicated diabetes groups. Meta-analysis investigating the difference in response to thermal hyperaemia demonstrated a significant difference in cutaneous microvascular reactivity between Charcot neuroarthropathy and peripheral neuropathy with a large, pooled effect size (SMD 1.46 95% CI: 0.89–2.02) and low heterogeneity (I2 = 4%, T2 = 0.01) indicating that the cutaneous microvascular response is more impaired in peripheral neuropathy than in Charcot neuroarthropathy.

Conclusions
Charcot neuroarthropathy is associated with greater cutaneous microvascular reactivity in the periphery relative to diabetes cohorts with diabetes-related peripheral neuropathy alone. It is unknown if this occurs prior to, or as a result of, Charcot neuroarthropathy.
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