Fatores de risco modificáveis para Neuroartropatia de Charcot no paciente diabético: Uma revisão sistemática.

Abstract

Introduction: Among Diabetic neuropathic Foot Complications the Charcot neuroarthropathy (CN) is noteworthy, threatening condition to the lower limbs and lives of people with diabetes mellitus. It is a noninfectious inflammatory disease marked by disorganization in various stages of joint and bone. The delay in the diagnosis of more than three months adversely affects the quality of life of patients and functional outcome of the disease. Materials and Methods: a systematic review were performed of the literature Published in the period between July 2005 and July 2015, guided by the question: What are the modifiable risk factors of early onset in diabetic patients leading to CN? The following databases were consulted: PubMed, Web of Science, Scopus and Lilacs. Articles found have gone through a selection protocol. Results: Were found 400 articles, however, after the selection protocol, 13 were chosen. These articles had the following risk factors: non-Hispanic whites ethnic and aboriginal, diabetes duration, social isolation, previous foot ulcer, obesity isolated or associated with neuropathy, high levels of HbA1c, chronic use of high doses of corticosteroids, increased maximal response of vascular hyperemia, renal failure, rheumatoid arthritis, iron deficiency anemia, use of insulin, presence of micro and macrovascular complications, lack of CC genotypes and TT [frequency of the C allele (gene in G1181C) + T (T245G gene)] and the presence of polymorphisms 1181G> C and 950T> C in the osteoprotegerin gene. As a protective factor, we found peripheral arterial disease. The risk factor age was controversial. Conclusion: Many risk factors are related to an inefficient management of diabetes mellitus, indicating poor health care to this group of patients. Others are related to socio-demographic and genetic characteristics. Knowledge of modifiable risk factors for early onset of CN in the diabetic can result in a more efficient preventive clinical approach. However, further investigations are necessary to validate, refute or expand perceptions and approaches to modifiable risk factors for CN.