Charcot

• Disorganization of a joint and destruction of joint surfaces associated with diminished pain sensation which is most commonly due to:
• Causes:
  • tabes dorsalis
  • diabetes mellitus
  • syringomyelia
  • Charcot-Marie-Tooth disease
  • meningomyelocele
  • hemiplegia
  • leprosy
• Joints affected: monoarticular, depends on localization of pain loss
• Symptoms:
  • 50% have acute onset of pain and swelling
  • pain is absent in the later stages
• Signs:
  • acute stage - red, warm, tender, swollen joint
  • chronic stage - bony swelling and recurrent effusion, instability, crepitus, deformities
• Course: acute inflammatory stage lasts for up to 6 months, with subsequent slow progression for years until deformities occur
• X-ray: sclerosis of the bone ends, loss of the joint space, loose bodies, massive osteophytes, periarticular calcification, fractures
• Labs: essentially normal chemistries. Do immunologic tests (antibodies to listed bacterial infections)
• Treatment: rest in the acute stage, NSAIDS, stabilization with braces and splints, arthrodesis for instability
• Conditions associated with neuropathic joints:
  • Tabes Dorsalis: knee is most common site (70%), with ankle and feet (30%), Argyll Robinson pupil (80%), absent DTR's
  • Syringomyelia: 50% have cervical spondylosis on x-ray, loss of pain and temperature in the upper extremities, equinus deformities
  • Diabetes Mellitus: 1 % of diabetics and 5% with diabetic neuropathy have a neuropathic joint, foot is most common site (80%), absent ankle jerk, sensory loss