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Definition
A chronic, progressive and degenerative disease of one or more joints, characterized by swelling, instability of the joint, hemorrhage, heat, and atrophic and hypertrophic changes in the bone. It is also known as neurogenic arthropathy.
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Description
This disease is the result of a neurologic disorder, diabetic neuropathy, leprosy, congenital absence or the depression of pain sensation. In some cases, early recognition of this disease and prophylactic protection of the joint may prevent further damage. Because of slow healing, surgical reconstruction is not usually effective.
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Causes and Risk Factors
A joint without a nerve supply is particularly affected. The cartilage degenerates, the bone fractures and distorts, and then the joint becomes all but useless. This may take only a few months or a few years. Charcot's joint usually affects the knees, although other weight-bearing joints may be affected also. The affected joint is massively swollen, distorted and unstable. In the leg (below the affected joint) there is a loss of nerve connections and the physician may find a defect in pain and position perception.
In diabetics, this problem can create major and severe deformities of the foot unless it is recognized and treated during the early stages. Charcot's joint usually occurs in diabetics who have had the disease for a long time. If you maintain good control of your diabetes through diet, medication and monitoring, you can reduce your future risks for this condition, as well as other diabetes complications.
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Symptoms
Pain is usually less severe than expected by the appearance of the joint in an x-ray film. The joint may be boggy or swollen.
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Diagnosis
The x-rays can show loss of cartilage, new bone growth and frequently fractures at the joint. There are no laboratory test abnormalities in these conditions, except those of the underlying disease.
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Treatment
The underlying disease may be treated effectively if it is syphilis or to some extent, diabetes. However, the nerves will not regenerate after treatment of the disease and the joint problem may continue to worsen. Protection of the joints by minimizing weight with crutches or a cane is important. Drugs are of limited benefit. Surgery is only rarely attempted and only moderately successful.
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Questions to Ask Your Doctor
What is the underlying disease or cause of Charcot's joint?
What treatment will be used to stop the underlying cause?
What is the severity of the joint damage?
Are there any other joints slightly affected?
Will the joint deteriorate more and how much?
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