Uncommon coincidence of Charcot osteoarthropathy with enteropathic arthritis

Overview

The authors refer here a rare coincidence of two independent rheumatic diseases. The symptoms of both conditions have been underestimated for a long time Therefore the correct diagnosis was delayed and disease lead to destructive changes of lower extremity joints. This case describes 29-year-old patient with insulin-dependent diabetes mellitus type 1 diagnosed at the age of 11 years with multiorgan complications, fluctuating glycaemia levels, two year’s history of left ankle arthritis, and newly appeared arthritis of the right knee. She mentioned recurrent diarrhoea during last 3 years that has been assessed as a part of diabetic neuropathy. High acute phase reactants, hypochromic anemia, proteinuria, and HLA B27 positivity have been detected in laboratory tests. X-ray showed a severe talus and tibia destruction and neuropathic joint was confirmed by magnetic resonance. Subsequent gastroenterological examination diagnosed acute Crohn’s disease of the terminal ileum. Afterwards, the disease was reevaluated as an enteropathic arthritis due to Crohn’s disease with the development of Charcot joint in the region of left ankle due to diabetic polyneuropathy. When sufficient treatment in cooperation with gastroenterologist, orthopedic surgeon, and podiatric physician was introduced, most of the signs and symptoms of arthritis, diarrhea, and diabetes mellitus have improved, including the situation of the left ankle.

Key words:
diabetes mellitus, Charcot osteoarthropathy, enteropathic arthritis, Crohn’s disease