Charcot joint
Updates to Article Attributes
A Charcot joint (also known as a neurotrophic joint) refers to a progressive degenerative / destructive/destructive joint disorder in patients with abnormal pain sensation and proprioception 1.
Epidemiology
In modern western societies by far the most common cause of Charcot joints is diabetes, and therefore the demographics of patients matches those of older diabetics. Causes include:
These can be recalled using the mnemonic - DS6 1. The involved joint is highly suggestive of the aetiology:
- wrist
-: diabetes, syringomyelia - hip
-: alcohol, tabes dorsalis - knee
-: tabes dorsalis, congenital insensitivity to pain - ankle and foot
-: diabetes - spine
-: spinal cord injury, diabetes, tabes dorsalis
Clinical presentation
Patients typically present insidiously or are identified incidentally or as a result of investigation for deformity. Unlike septic arthritis, Charcot joints although swollen are normal temperature without elevated inflammatory markers. Importantly they are painless.
Pathology
Two forms exist (atrophic and hypertrophic).
Atrophic form
- most common form 1
- occurs earlier 2
- has an acute progression
- characterised by reabsorption of the ends of the effected bone
- joint destruction with resorption of fragments
- absence of osteosclerosis and osteophytes
- mainly occurs on non weight bearing joints of the upper limb 1
Hypertrophic form
- only sensory nerves effected
- slow progression
- joint destruction with periarticular debris
/ bone/bone fragmentation - initially widened then narrowed joint space
- presence of osteosclerosis and osteophytes1
- absence of osteoporosis (unless joint is infected) 3
Radiographic features
Mnemonic - : 6 Ds 1
- dense bones (subchondral sclerosis)
- degeneration
- destruction of articular cartilage
- deformity (pencil-point deformity of metatarsal heads)
- debris (loose bodies)
- dislocation
Differential diagnosis
Imaging differential considerations include
- advanced osteomyelitis
- can: can co exist (especially in the foot) 4-5 - tuberculous spondylitis/Pott's disease (in the spine)
-
chondrosarcoma (shoulder)
-: chondroid matrix instead of bony debris - inflammatory osteoarthritis
/ arthritis -/arthritis: early stages can resemble Charcot's joint
EtymologyHistory and etymology
Jean-Martin Charcot was the first person to give a detailed description of the neuropathic aspect of this condition in the year 1868 in a patient suffering with syphilis.
-<p>A <strong>Charcot joint</strong> (also known as a <strong>neurotrophic joint</strong>) refers to a progressive degenerative / destructive joint disorder in patients with abnormal pain sensation and proprioception <sup>1</sup>.</p><h4>Epidemiology</h4><p>In modern western societies by far the most common cause of Charcot joints is diabetes, and therefore the demographics of patients matches those of older diabetics. Causes include: </p><ul>- +<p><strong>Charcot joint</strong> (also known as a <strong>neurotrophic joint</strong>) refers to a progressive degenerative/destructive joint disorder in patients with abnormal pain sensation and proprioception <sup>1</sup>.</p><h4>Epidemiology</h4><p>In modern western societies by far the most common cause of Charcot joints is diabetes, and therefore the demographics of patients matches those of older diabetics. Causes include: </p><ul>
-<li>wrist - diabetes, <a href="/articles/syringomyelia">syringomyelia</a>- +<li>wrist: diabetes, <a href="/articles/syringomyelia">syringomyelia</a>
-<li>hip - alcohol, <a href="/articles/tabes-dorsalis">tabes dorsalis</a>- +<li>hip: alcohol, <a href="/articles/tabes-dorsalis">tabes dorsalis</a>
-<li>knee - <a href="/articles/tabes-dorsalis">tabes dorsalis</a>, congenital insensitivity to pain</li>-<li>ankle and foot - diabetes</li>-<li>spine - spinal cord injury, diabetes, <a href="/articles/tabes-dorsalis">tabes dorsalis</a>- +<li>knee: <a href="/articles/tabes-dorsalis">tabes dorsalis</a>, congenital insensitivity to pain</li>
- +<li>ankle and foot: diabetes</li>
- +<li>spine: spinal cord injury, diabetes, <a href="/articles/tabes-dorsalis">tabes dorsalis</a>
-<li>joint destruction with periarticular debris / bone fragmentation</li>- +<li>joint destruction with periarticular debris/bone fragmentation</li>
-<li>presence of osteosclerosis and osteophytes<sup>1</sup>- +<li>presence of osteosclerosis and osteophytes <sup>1</sup>
-</ul><h4>Radiographic features</h4><p><strong>Mnemonic</strong> - <a href="/articles/6-ds">6 Ds</a> <sup>1</sup></p><ul>- +</ul><h4>Radiographic features</h4><p><strong>Mnemonic</strong>: <a href="/articles/6-ds">6 Ds</a> <sup>1</sup></p><ul>
-<li>advanced <a href="/articles/osteomyelitis">osteomyelitis </a>- can co exist (especially in the foot) <sup>4-5</sup>- +<li>advanced <a href="/articles/osteomyelitis">osteomyelitis</a>: can co exist (especially in the foot) <sup>4-5</sup>
-<a href="/articles/tuberculous-spondylitis-1">tuberculous spondylitis</a> / <a href="/articles/pott-disease">Pott's disease</a> (in the spine) </li>- +<a href="/articles/tuberculous-spondylitis-1">tuberculous spondylitis</a>/<a href="/articles/pott-disease">Pott's disease</a> (in the spine) </li>
-<a href="/articles/chondrosarcoma">chondrosarcoma</a> (shoulder) - <a href="/articles/chondroid-matrix">chondroid matrix</a> instead of bony debris</li>-<li>inflammatory <a href="/articles/osteoarthritis">osteoarthritis</a> / arthritis - early stages can resemble Charcot's joint</li>-</ul><h4>Etymology</h4><p>Jean-Martin Charcot was the first person to give a detailed description of the neuropathic aspect of this condition in the year 1868 in a patient suffering with syphilis.</p>- +<a href="/articles/chondrosarcoma">chondrosarcoma</a> (shoulder): <a href="/articles/chondroid-matrix">chondroid matrix</a> instead of bony debris</li>
- +<li>inflammatory <a href="/articles/osteoarthritis">osteoarthritis</a>/arthritis: early stages can resemble Charcot's joint</li>
- +</ul><h4>History and etymology</h4><p><strong>Jean-Martin Charcot</strong> was the first person to give a detailed description of the neuropathic aspect of this condition in the year 1868 in a patient suffering with syphilis.</p>