Neurogenic arthropathy
Neurogenic arthropathy: Excerpt from Professional Guide to Diseases (Eighth Edition)
Neurogenic arthropathy, also called Charcot’s arthropathy, is a progressively degenerative disease of peripheral and axial joints, resulting from impaired sensory innervation. The loss of sensation in the joints causes progressive deterioration, resulting from trauma or primary disease, which leads to laxity of supporting ligaments and eventual disintegration of the affected joints.
Causes
Neurogenic arthropathy is most common in men older than 40 years. In adults, the most common cause of neurogenic arthropathy is diabetes mellitus. Other causes include tabes dorsalis (especially among patients age 40 to 60), syringomyelia (progresses to neurogenic arthropathy in about 25% of patients),myelopathy of pernicious anemia, spinal cord trauma, paraplegia, hereditary sensory neuropathy, and Charcot-Marie-Tooth disease. Amyloidosis, peripheral nerve injury, myelomeningocele (in children), leprosy, and alcoholism may cause neurogenic arthropathy, but only in rare occurrences.
Frequent intra-articular injection of corticosteroids has also been linked to neurogenic arthropathy. The analgesic effect of the corticosteroids may mask symptoms and allow continuous stress to accelerate joint destruction.
Signs and symptoms
Neurogenic arthropathy begins insidiously with swelling, warmth, decreased mobility, and instability in a single joint or in many joints. It can progress to deformity. The first clue to vertebral neuroarthropathy, which progresses to gross spinal deformity, may be nothing more than a mild, persistent backache. Characteristically, pain is minimal despite obvious deformity.
The specific joint affected varies according to the underlying cause. Diabetes usually attacks the joints and bones of the feet; tabes dorsalis attacks the large weight-bearing joints, such as the knee, hip, ankle, or lumbar and dorsal vertebrae (Charcot spine); syringomyelia causes occurrence in the shoulder, elbow, or cervical intervertebral joint. Neurogenic arthropathy caused by intra-articular injection of corticosteroids usually develops in the hip or knee joint.
Diagnosis
Patient history of painless joint deformity and underlying primary disease suggests neurogenic arthropathy. Physical examination may reveal bone fragmentation in advanced disease. X-rays confirm diagnosis and assess severity of joint damage. In the early stage of the disease, soft-tissue swelling or effusion may be the only overt effect; in the advanced stage, articular fracture, subluxation, erosion of articular cartilage, periosteal new bone formation, and excessive growth of marginal loose bodies (osteophytosis) or resorption may be seen. Computed tomography scan helps define the extent of disease.
Other diagnostic measures include:
❑ vertebral examination: narrowing of disk spaces, deterioration of vertebrae, and osteophyte formation, leading to ankylosis and deforming kyphoscoliosis
❑ synovial biopsy: bony fragments and bits of calcified cartilage.
Treatment
Effective management relieves pain with analgesics and immobilization using crutches, splints, braces, and restriction of weight bearing to the affected joint.
In severe disease, surgery may include arthrodesis or, in severe diabetic neuropathy, amputation. However, surgery risks further damage through nonunion and infection.
Special considerations
Assess the pattern of pain and give analgesics, as needed. Check sensory perception, range of motion, alignment, joint swelling, and the status of underlying disease.
❑ Teach the patient to use joint protection techniques, to avoid physically stressful actions that may cause pathologic fractures, and to take safety precautions, such as removing throw rugs and other objects over which the patient may trip.
❑ Advise the patient to report severe joint pain, swelling, or instability. Warm compresses may be applied to relieve local pain and tenderness.
❑ Instruct the patient in the proper technique for crutches or other orthopedic devices. Stress the importance of proper fitting and regular professional readjustment of such devices. Warn the patient that impaired sensation might allow damage from these aids to occur and progress without discomfort.
❑ Emphasize the need to continue regular treatment of the underlying disease.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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