Neuropathic Arthropathy
Most common in males older than age 40, neuropathic arthropathy (also called Charcot’s arthropathy) is a progressively degenerative disease of the peripheral and axial joints resulting from impaired sensory innervation. Trauma or disease results in a loss of sensation in the joint, which damages the supporting ligaments. Eventually, the affected joint disintegrates.
The specific joints affected vary. Diabetes mellitus usually attacks joints and bones of the feet. Tabes dorsalis affects large, weight-bearing joints, such as the knee, hip, ankle, or lumbar and dorsal vertebrae. Syringomyelia involves the shoulder, elbow, or cervical intervertebral joint. Neuropathic arthropathy caused by intra-articular corticosteroid injections may develop in the hip or knee joint.
Causes
In adults, the most common cause of neuropathic arthropathy is diabetes mellitus. Other causes include syringomyelia (which progresses to neuropathic arthropathy in about one of four patients), myelopathy of pernicious anemia, spinal cord trauma, paraplegia, hereditary sensory radicular neuropathy, and Charcot-Marie-Tooth disease. Rarely, tabes dorsalis, amyloidosis, peripheral nerve injury, leprosy, or alcoholism causes neuropathic arthropathy.
Frequent intra-articular injection of corticosteroids has also been linked to neuropathic arthropathy. The analgesic effect of the corticosteroids may mask symptoms and allow continuous damaging stress to accelerate joint destruction.
Complications
Neuropathic arthropathy can lead to joint subluxation or dislocation, pathologic fractures, infection, pseudogout, or neurovascular compression.
Assessment
The patient’s history may reveal an insidious onset, underlying neurologic disease, previous pathologic fractures, trauma and swelling in the affected area, and progressively worsening symptoms. Even with marked swelling over the joints, the patient may report no pain.
Inspection and other physical assessment techniques disclose extreme joint swelling, increased joint range of motion, joint deformity and instability, dislocation or subluxation, and loss of muscle tone around the joint. Palpation may detect warmth or tenderness over the involved joints. In rare cases, loose objects and abnormal calcifications in the joint may be
felt. (The joint may feel like a “bag of bones.”)
felt. (The joint may feel like a “bag of bones.”)
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