- Disorganization of a joint and destruction of joint surfaces associated with diminished pain sensation which is most commonly due to:
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Causes:
- tabes dorsalis
- diabetes mellitus
- syringomyelia
- Charcot-Marie-Tooth disease
- meningomyelocele
- hemiplegia
- leprosy
- Joints affected: monoarticular, depends on localization of pain loss
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Symptoms:
- 50% have acute onset of pain and swelling
- pain is absent in the later stages
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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
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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
