Charcot first described neuropathic arthropathy in 1868, hence it is also known as Charcot arthropathy. This condition is caused by a lack of pain sensation and is also referred to as painless arthropathy. It commonly occurs in individuals aged 40 to 60, with a male-to-female ratio of 3:1.

bubble_chart Etiology

It can occur in the central nervous system syphilis, syringomyelia, diabetic nature of disease neuropathy, spinal membrane protrusion, congenital analgesia, etc. In these cases, joints such as the shoulder, elbow, cervical spine, hip, knee, ankle, and toe are damaged due to overuse and impact caused by the lack of pain sensation as a protective mechanism. Additionally, long-term use of corticosteroids (such as in the treatment of rheumatoid arthritis, systemic lupus erythematosus, and post-organ transplantation) or painkillers (e.g., phenylbutazone, indomethacin) can lead to iatrogenic joint destruction with the same mechanism of disease. Syringomyelia of the cervical spinal cord is a common neurological nature of disease disorder affecting the upper limb joints. The shoulder, elbow, cervical spine, and wrist are frequently involved sites. Approximately 25% of syringomyelia cases are accompanied by upper limb joint destruction. Besides joint lesions, unilateral or bilateral loss of temperature sensation may occur, leading to burn scars on the skin of the upper limbs. Spinal syphilis, also known as tabes dorsalis, often affects the knees, hips, ankles, and lumbar spine. In addition to bone and joint changes, symptoms may include motor ataxia, impaired deep sensation in the lower limbs, Argyll-Robertson pupils, and a positive serum Wassermann reaction. In cases of spinal protrusion, the ankle and small joints of the foot are commonly affected. Painless ulcers may appear on the soles of the feet, along with soft tissue masses, skin dimpling or hypertrichosis in the lumbosacral region, muscle atrophy, sensory loss in the lower limbs, and sphincter dysfunction. Diabetic nature of disease neuropathy can lead to painless swelling in small joints of the foot (such as the tarsus, metatarsus, toes, interphalangeal joints, etc.).

bubble_chart Clinical Manifestations

Neuropathic arthropathy is characterized by gradual joint enlargement, instability, and effusion, with the joint potentially discharging bloody fluid. Swollen joints are often painless or only exhibit mild distending pain, with minimal functional limitation. A hallmark of this disease is the discrepancy between joint pain/functional impairment and the degree of joint swelling and destruction. In advanced stages, progressive joint damage may lead to pathological fractures or pathological joint dislocations.

bubble_chart Auxiliary Examination

X-ray examination shows soft tissue swelling in the early stage, with dense bone ends. In the advanced stage, the joint displays varying degrees of destruction, narrowing of the space, dense bone ends, pathological fractures, loose bodies within the joint, bone resorption, degenerative osteophytes and new bone formation, as well as joint dislocation and deformity.

bubble_chart Treatment Measures

① For affected joints, avoid strenuous work in the upper limbs and minimize weight-bearing in the lower limbs. ② Severely damaged joints (such as knees, elbows, and spine) can be protected with braces. ③ Amputation may be performed for severe foot conditions with non-healing ulcers. Young adults with severe destruction of knee or ankle joints may undergo joint fusion, though adjacent joints may still develop the disease. Reducing activity and using braces are commonly effective methods.