Neuropathic arthropathy is caused by progressive joint destruction, often very rapid, that develops because people cannot sense pain, continually injure joints, and thus are not aware of the early signs of joint damage.
Neuropathic arthropathy results from an underlying disorder that affects the nerves, such as diabetes and stroke.
People develop neuropathic arthropathy because they cannot feel injuries that damage their joints.
Typical symptoms include stiffness, fluid, and pain in the joints.
The diagnosis is based on x-rays.
Treatment of the underlying nerve disorder and stabilization of joints and fractures, and sometimes surgery, can help slow disease progression and reduce pain.
Any joint can be affected depending on where the nerve damage is located. The most commonly affected joints are
The knee and ankle
In people who have diabetes, the joints in the foot
Often, only one area is affected, such as the foot and ankle, and usually not more than two or three joints.
Causes of Neuropathic Arthropathy
When certain nerves are damaged, people may become unable to sense pain. A variety of disorders, such as diabetes mellitus, spinal cord disorders (such as injuries and fluid-filled cavities in the spinal cord [syringomyelia]), and syphilis, can damage these nerves. The most common causes are
People with nerve damage may injure a joint many times without noticing. Injuries may occur for years with accumulated joint damage before the joint malfunctions. However, once it malfunctions, the joint may be permanently destroyed within a few months.
Symptoms of Neuropathic Arthropathy
In its early stages, neuropathic arthropathy appears similar to osteoarthritis because the joints are stiff and fluid may accumulate in them. Pain is a common early symptom. However, because the ability to sense pain is commonly impaired, the degree of pain is often unexpectedly mild considering the amount of joint damage. Despite this, if the disorder progresses rapidly, the joint can become extremely painful. In these cases, the joint is usually swollen because of excess fluid and abnormal bone growth. It may look deformed because it has been fractured and ligaments have stretched, allowing loose pieces of bone and cartilage to slip out of place. Moving the joint may cause a coarse, grating sound because of bone fragments floating in the joint.
Different joints are affected by different underlying disorders. For example, complications of untreated syphilis affect the knee and hip, and diabetes mellitus affects the foot and ankle. Syringomyelia commonly affects the cervical (neck) spine and thus the upper limb joints, especially the elbow and shoulder.
People rarely develop a second arthritis that is caused by bacteria (see Infectious Arthritis) and may or may not have the fever or general feeling of illness (malaise) that typically occurs with infectious arthritis. Infectious arthritis is particularly likely in people with diabetes.
Structures such as blood vessels, nerves, and the spinal cord can become compressed because of bony overgrowth.
Diagnosis of Neuropathic Arthropathy
X-rays
Doctors suspect neuropathic arthropathy when people have a disorder that affects the nerves and have typical symptoms of joint problems.
X-rays can detect joint damage, which often includes calcium deposits and abnormal bone growth, and deformities.
Treatment of Neuropathic Arthropathy
Treatment of the underlying nerve disorder
Surgery to repair or replace joints
Treatment of the underlying nerve disorder can sometimes slow or even reverse joint damage. Stabilizing painless fractures and splinting unstable joints can help stop or minimize the damage.
Hip and knee joints may be surgically repaired or replaced with an artificial joint. However, people are at a higher risk of complications, such as the artificial joint loosening and dislocating.
Prevention of Neuropathic Arthropathy
Avoiding injuries and using protective wear, such as splints or special boots
Sometimes neuropathic arthropathy can be prevented by taking care of the feet and by avoiding injuries.
Splints or special boots can sometimes help protect vulnerable joints. Stabilizing the joints may prevent neuropathic arthropathy in a person at risk.
