[Diabetic Charcot neuroarthropathy initially misdiagnosed as rheumatoid arthritis and gout: A case report]

Charcot neuroarthropathy (CN) is a rare but severely disabling complication most commonly seen in patients with longstanding diabetic peripheral neuropathy. CN is characterized by progressive destruction, dislocation, and deformity of the foot and ankle joints, often accompanied by altered biomechanics, chronic ulceration, secondary infection, and, in advanced cases, a high risk of amputation or even mortality. The early clinical presentation of CN is frequently atypical, with mild or painless swelling, warmth, and erythema due to underlying sensory deficits, which can easily lead to misdiagnosis as other rheumatic or autoimmune joint disorders such as rheumatoid arthritis and gout. In this report, we present the case of a 60-year-old woman with a 12-year history of type 2 diabetes mellitus who developed persistent swelling and pain in her left ankle for eight months, along with progressive numbness in her left foot for six months. Her initial laboratory and imaging findings suggested a diagnosis of rheumatoid arthritis combined with gout, resulting in the administration of anti-rheumatic and uric acid-lowering therapies, which proved ineffective. Further diagnostic workup, including advanced imaging modalities, neuroelec-trophysiological testing, and synovial biopsy, ultimately confirmed the diagnosis of diabetic Charcot neuroarthropathy, revealing severe joint dislocation, bone fragmentation, and extensive osteolysis. The patient received comprehensive management, including strict glycemic control, anti-osteoporosis treatment, neurotrophic support, and ultimately underwent left ankle multi-joint fusion surgery. During postoperative follow-up, the patient demonstrated significant improvement in limb function, with no recurrence of ulcers or infection. This case highlights the importance of considering CN in diabetic patients with unilateral, painless joint swelling, deformity, and sensory disturbance. Accurate differential diagnosis from rheu-matic and autoimmune diseases, early recognition, and standardized intervention are crucial to prevent irreversible deformity and reduce the risk of amputation, ultimately improving patient outcomes. Early multidisciplinary management and individualized treatment strategies play a key role in optimizing prognosis for patients with diabetic CN.