Gooday Catherine, Hardeman Wendy, Poland Fiona, Woodburn Jim, Dhatariya Ketan
Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK.
Behavioural and Implementation Science Group, School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
Ther Adv Endocrinol Metab. 2023 Apr 17;14:20420188231160406. doi: 10.1177/20420188231160406. eCollection 2023.
Charcot neuroarthropathy (CN) was first described over 150 years ago. Despite this there remains uncertanity around the factors that contribute to its development, and progression. This article will discuss the current controversies around the pathogenesis, epidemiology, diagnosis, assessment and management of the condition. The exact pathogenesis of CN is not fully understood, and it is likely to be multifactorial, with perhaps currently unknown mechanisms contributing to its development. Further studies are needed to examine opportunities to help screen for and diagnose CN. As a result of many of these factors, the true prevalence of CN is still largely unknown. Almost all of the recommendations for the assessment and treatment of CN are based on low-quality level III and IV evidence. Despite recommendations to offer people with CN nonremovable devices, currently only 40-50% people are treated with this type of device. Evidence is also lacking about the optimal duration of treatment; reported outcomes range from 3 months to more than a year. The reason for this variation is not entirely clear. A lack of standardised definitions for diagnosis, remission and relapse, heterogeneity of populations, different management approaches, monitoring techniques with unknown diagnostic precision and variation in follow-up times prevent meaningful comparison of outcome data. If people can be better supported to manage the emotional and physical consequences of CN, then this could improve people's quality of life and well-being. Finally, we highlight the need for an internationally coordinated approach to research in CN.
夏科氏神经关节病（CN）早在150多年前就有了相关描述。尽管如此，对于其发病和进展的影响因素仍存在不确定性。本文将探讨围绕该病发病机制、流行病学、诊断、评估及管理方面的当前争议。CN的确切发病机制尚未完全明了，很可能是多因素的，或许目前还有未知机制在其发病过程中起作用。需要进一步研究以探寻有助于筛查和诊断CN的机会。由于诸多此类因素，CN的真实患病率仍很大程度上未知。几乎所有关于CN评估和治疗的建议都基于低质量的III级和IV级证据。尽管建议为CN患者提供不可拆卸装置，但目前仅有40%至50%的患者接受此类装置治疗。关于最佳治疗时长的证据也很缺乏；报告的治疗结果从3个月到一年多不等。这种差异的原因尚不完全清楚。诊断、缓解及复发缺乏标准化定义，人群异质性、不同管理方法、诊断精度未知的监测技术以及随访时间的差异，阻碍了对结局数据进行有意义的比较。如果能更好地帮助患者应对CN带来的情绪和身体影响，那么这可能会改善患者的生活质量和幸福感。最后，我们强调需要采取国际协调的方法来开展CN研究。
