Charcot neuro-osteoarthropathy: comprehensive epidemiological analysis from a large multicenter study

Aims: Charcot neuro-osteoarthropathy (CNO) is a severe complication of diabetes, yet data on epidemiological characteristics remain limited. This multicenter observational study aimed to assess the demographic and clinical characteristics of CNO in patients with type 1 (T1D) and type 2 (T2D) diabetes across six countries over a 26-year period.

Methods: Data were collected from eight specialized diabetic foot clinics from six countries between 1996 and 2022, including 774 patients diagnosed with CNO. All data were obtained from medical records. Key variables analyzed included age at diagnosis, diabetes type, duration of diabetes, and the prevalence of microvascular complications (neuropathy, retinopathy, nephropathy). Distal polyneuropathy (DPN) being assessed by the neuropathy disability score, vibration perception threshold, and monofilament testing. Statistical comparisons were made between patients with T1D and T2D.

Results: The mean age at CNO diagnosis was 55 years, with 72 % of cases occurring in males. Most patients (83 %) had T2D, with a median diabetes duration of 15 years. DPN was the most prevalent complication (92 %), followed by retinopathy (60 %) and nephropathy (45 %). Patients with T1D tended to develop CNO at a younger age (47 years vs. 58 years in T2D) and had a longer diabetes duration (29 years vs. 14 years). DPN and other microvascular complications were significantly more frequent in T1D than in T2D at CNO diagnosis.

Conclusions: CNO primarily affects males with longstanding diabetes and is strongly associated with DPN and other microvascular complications. When compared to T2D, patients with T1D are diagnosed with CNO at an earlier age, and are characterized by a longer diabetes duration and a larger burden of microvascular complications. These findings could help improve early detection of CNO.

Comments: This study provides valuable epidemiological insight into CNO, a disabling yet underrecognized complication of diabetes. Diagnosing CNO can be challenging due to overlapping clinical presentations with other conditions, often leading to delayed diagnosis. Moreover, because CNO is a rare complication, large-scale studies are lacking, and little is known about its pathophysiology, exact prevalence, or incidence. A key strength of this study is its large, multicenter dataset spanning multiple countries and decades, which enhances the generalizability of its findings. The detailed stratification of patients by diabetes type further strengthens the analysis, highlighting important differences in CNO onset, presentation, and associated complications between T1D and T2D. However, some limitations should be acknowledged. The retrospective study design may introduce selection bias, as only patients who presented at specialized diabetic foot clinics were included, potentially overlooking milder or undiagnosed cases. Additionally, DPN and CNO-case classification may have been influenced by variations in diagnostic criteria across centers and the reliance on medical records rather than clinical assessments. Overall, the findings align with existing literature, reinforcing DPN as a primary driver of CNO, with male sex, age, and diabetes duration as additional key risk factors. The study’s large scale and broad applicability underscore key risk factors that could aid in raising awareness of the complication, enhancing early screening, and improving diagnosis in high-risk populations. Furthermore, these results provide a strong foundation for future research into pathophysiological mechanisms and preventive strategies for CNO.

Anders Stouge  

Reference: Jude EB, Siafarikas C, Rastogi A, Bem R, Tankova T, Kong MF, LaFontaine J, Pappachan J, Tentolouris N. Demographic and Clinical Characteristics of Patients With Charcot Neuro-Osteoarthropathy in People With Diabetes Mellitus in Six Countries: A Multicenter Observational Study From 1996 to 2022. J Diabetes Res. 2025 Jan 8;2025:4275741. doi: 10.1155/jdr/4275741. PMID: 39817102; PMCID: PMC11735061.

🔗 https://onlinelibrary.wiley.com/doi/10.1155/jdr/4275741