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Harrison's Principles of Internal Medicine, 17e
| Part Fourteen: Disorders of the Immune System, Connective Tissue, and Joints > Section 3: Disorders of the Joints and Adjacent Tissues > |
Other Arthritides
Sections: Neuropathic
Joint Disease, Pathology and
Pathophysiology, Clinical Manifestations, Diagnosis, Neuropathic
Joint Disease: Treatment, Hypertrophic
Osteoarthropathy and Clubbing, Pathology and
Pathophysiology, Clinical Manifestations, Laboratory Findings, Hypertrophic
Osteoarthropathy: Treatment, Reflex Sympathetic
Dystrophy Syndrome, Tietze Syndrome
and Costochondritis.
Topics Discussed: arthritis; arthropathy, neurogenic; clubbing; costochondritis; hypertrophic osteoarthropathy; primary hypertrophic osteoarthropathy; reflex sympathetic dystrophy; thyroid acropachy.
Excerpt:
"Neuropathic joint disease (Charcot's joint) is a progressive
destructive arthritis associated with loss of pain sensation, proprioception,
or both. In addition, normal muscular reflexes that modulate joint
movement are decreased. Without these protective mechanisms, joints
are subjected to repeated trauma, resulting in progressive cartilage
and bone damage. Neuropathic arthropathy was first described by
Jean-Martin Charcot in 1868 in patients with tabes dorsalis. The
term Charcot joint is commonly used
interchangeably with neuropathic joint.
Today, diabetes mellitus is the most frequent cause of neuropathic
joint disease (Fig. 330-1). A variety of
other disorders are associated with neuropathic arthritis including
leprosy, yaws, syringomyelia, meningomyelocele, congenital indifference
to pain, peroneal muscular atrophy (Charcot-Marie-Tooth disease),
and amyloidosis. An arthritis resembling neuropathic
joint disease is seen in patients who have received frequent intraarticular
glucocorticoid injections into a weight-bearing joint and in patients
with CPPD. The distribution of joint involvement depends on the
underlying neurologic disorder (Table 330-2).
In tabes dorsalis, knees, hips, and ankles are most commonly..."
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