Markers of Inflammation and Bone Turnover in Type 2 Diabetic Patients at Risk of Charcot Arthropathy

Recent research indicates that inflammation-induced changes in the RANKL/RANK/OPG pathway play a significant role in the development of Charcot arthropathy. Considering the severe implications of Charcot arthropathy, cost-effective screening of patients at risk of the disease could prove to be an effective preventative strategy. As an initial endeavour in our attempt to identify a predictive biomarker for Charcot arthropathy, we conducted an analysis of inflammation and bone turnover markers in diabetic patients at risk of Charcot arthropathy. We then compared these markers with those of patients in the acute stage of Charcot arthropathy and healthy controls.

In this cross-sectional study, 45 subjects were carefully selected and categorized into three groups, with 15 individuals in each group. Group 1 encompassed patients over 50 years of age, with more than 10 years of type 2 diabetes and severe neuropathy (DN). Group 2 consisted of patients diagnosed with acute-stage Charcot arthropathy (aCA), while Group 3 consisted of healthy, non-diabetic, age-matched controls (N). Serum inflammatory markers and bone turnover markers were analyzed across these groups.

Significant differences were only noted in the median values of HbA1c (P=0.000), VPT (P=0.000), and OPG (P=0.009) among the groups under study. No notable increase was observed in the serum levels of the inflammatory marker IL6 (P value - 0.071), the bone resorption marker TRAP5B (P value - 0.066), or the bone formation marker BALP (0.251) across the groups. However, a positive correlation was identified between IL-6 and OPG in the aCA group (r=0.900, P=0.001).

In alignment with the existing literature, serum OPG levels were found to be elevated in the aCA group compared to the control groups. The observed similarities in serum levels of IL6 and TRAP5B across the groups are noteworthy and warrant further investigation.