Neurogenic arthropathy, also known as Charcot joints, is a rare but severely debilitating disorder of the articular system. Diabetic neuropathy, syringomyelia, trauma, neurosyphilis, and many other diseases can induce this phenomenon. Severe neuropathy and vascular insufficiency lead to a rapidly progressive destruction of the joints with symptoms of swelling and erythema and only mild pain. The diagnosis rests on a detailed patient history, a thorough physical examination, and appropriate imaging studies that determine the underlying cause.
Neurogenic arthropathy, initially named as Charcot neuropathic osteoarthropathy, affects the joints and the skeletal system and possesses a chronic and progressive clinical course    . The pathogenesis stems from a diminished function of the sensory nerves arising due to significant peripheral neuropathy, which may be encountered in various conditions    . By far, the most common etiology is diabetic neuropathy, affecting up to 13% of cases suffering from severe forms of this ailment . Other notable causative factors are syringomyelia, neurosyphilis, trauma to the spinal or peripheral nerves, and several other conditions affecting the nervous system   . Virtually any joint can be affected by neurogenic arthropathy. Some studies have established that neurosyphilis present in the knee, whereas the foot and ankle are mainly targeted in diabetic patients  . The clinical presentation is distinguished by a somewhat rapid onset of erythema and swelling of the joint with minimal or mild accompanying pain, which is one of the reasons why patients present very late to the physician . A limited range of motion and stiffness is frequently observed, particularly in the shoulder joint . In addition to localized joint symptoms, autonomic dysfunction may be simultaneously present with complaints of constipation, urinary retention, erectile dysfunction, and arrhythmias  .
Entire Body System
The finding of considerable amounts of cartilaginous and osseous debris within the synovial membrane (termed detritic synovitis) should alert the pathologist that the changes may represent a neuropathic joint. [emedicine.com]
The eminent French pathologist and neurologist, Jean-Martin Charcot, was also there and gave a presentation on tabetic disease of the bones and joints. [doi.org]
It is seen in up to 9% of patients with diabetic neuropathy.  Similar pathology can also occur in the knee but is much less common and should be considered in a patient with peripheral neuropathy, who presents with a red, hot, tender, and swollen knee [emedicine.com]
Description A progressive destructive arthritis secondary to peripheral neuropathy and the associated loss of pain sensation. [unboundmedicine.com]
People rarely develop a second arthritis that is caused by bacteria (see Infectious Arthritis ) and may or may not have the fever or general feeling of illness (malaise) that typically occurs with infectious arthritis. [merckmanuals.com]
The patient was subsequently taken to theatre for washout and debridement of the right elbow for a suspected septic arthritis. [nzma.org.nz]
Differential diagnosis includes tumor and septic arthritis. We report a case of neurogenic hip arthropathy in a 30-year-old diabetic woman, and illustrate the clinical history and imaging findings. [link.springer.com]
Stage 1: Osseous fragmentation with joint dislocation seen on radiograph ("acute Charcot"). [en.wikipedia.org]
Ligamentous laxity, muscular hypotonia, and rapid destruction of joint cartilage are common, predisposing to joint dislocations, which also accelerate disease progression. [merckmanuals.com]
Neuropathic arthropathy is a progressive musculoskeletal disease that is evidenced by deformities, joint dislocation and fractures. This results in progressive destruction of bone and soft tissue of your weight-bearing joints. [disabilitycasereview.com]
Stage 1 : Osseous fragmentation with joint dislocation seen on radiograph ("acute Charcot"). [uwmsk.org]
The foot or ankle displays permanent enlargement and fixed deformity due to the bone fragments and joint dislocation healing in a displaced position. The skin color and temperature gradually normalize. [amputee-coalition.org]
Imaging Radiography indication for all patients findings can be normal in early Charcot joint acute bony consolidation with fractures, joint effusion, or bone destruction chronic bony deformity, new bone formation, and sclerosis resorption of bone Magnetic [medbullets.com]
Joint effusion, calcification within the joint capsule, loose bodies and increased density within the distal humerus, proximal radius and ulnar are evident. [nzma.org.nz]
Progressive joint effusion, fracture, fragmentation, and subluxation should raise the suspicion of neuroarthropathy. [emedicine.com]
Hemorrhagic joint effusions and multiple small fractures can occur, accelerating disease progression. [merckmanuals.com]
Swelling Diagnostic tests X-rays confirm the diagnosis and allow evaluation of damage. [medical-clinic.org]
Common manifestations include joint swelling, effusion, deformity, and instability. Pain may be disproportionately mild due to the underlying neuropathy. Diagnosis requires x-ray confirmation. [merckmanuals.com]
[…] a neutrally medicated persistent hyperaemia. 1,7 A further theory proposes that joint changes result from damage to central nervous system ‘trophic centres’ which control bone and joint nutrition. 1 The classical clinical presentation of NA involves joint [nzma.org.nz]
Swelling After an injury, the synovial fluid that leaks out of the joint capsule may produce swelling. [drfoot.co.uk]
The majority of patients with rheumatoid arthritis will test positive for rheumatoid factors and a rheumatoid arthritis diagnosis requires the presence of certain other symptoms: morning stiffness, multiple joint swelling, rheumatoid nodules, and evidence [physio-pedia.com]
If the patient later suffers from chronic arthralgias, corticosteroids should be avoided . Steroids are administered when inflammatory symptoms are resistant to NSAIDs . [physio-pedia.com]
The diagnosis of neurogenic arthropathy rests on the ability of the clinician to raise suspicion toward this disease. In order to gain sufficient evidence, a detailed physical examination and a thorough history are of critical importance. The presence of illnesses that could predispose to this condition, such as diabetes mellitus, must be excluded, while recent trauma is also an important risk factor. Once the course of symptoms, as well as their duration and progression, are assessed, the physical exam should cover a complete neurological workup, including reflex testing and evaluation of the sensory nerves . Neuropathy of any origin can be confirmed by using either the Semmes-Weinstein 5.07/10 g monofilament or simple pinprick testing, whereas the neurometer test might also be employed when possible  . A lower temperature of the affected joint and extremity is readily noted , thus further solidifying the diagnosis of neuropathic origin . To confirm the neurogenic arthropathy, imaging studies need to be performed. Plain radiography, although a very useful method for observing the skeletal system, is of limited benefit due to frequent involvement of soft tissues by local inflammation, which is why magnetic resonance imaging (MRI) is the gold standard    . Scintigraphy, use of Doppler probes, electrophysiology studies, and a skin biopsy are also recommended in the workup of individuals in whom neurogenic arthropathy is suspected .
Increased Bone Density
Inactive (chronic) condition: Characterized by resolution of inflammation, exuberant ossification, increased bone density, restoration of stability and foot deformity. -- To view the remaining sections of this topic, please sign in or purchase a subscription [hopkinsguides.com]
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