Charcot joint
Updates to Article Attributes
Charcot joint (also known as a neurotrophic joint) refers to a progressive degenerative/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
effectedaffected 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
effectedaffected - slow progression
- joint destruction with periarticular debris/bone fragmentation
- initially widened then narrowed joint space
- presence of osteosclerosis and osteophytes 1
- 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 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: early stages can resemble Charcot's joint
History 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.
-<li>characterised by reabsorption of the ends of the effected bone</li>- +<li>characterised by reabsorption of the ends of the affected bone</li>
-<li>only sensory nerves effected</li>- +<li>only sensory nerves affected</li>
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