Less Common Arthropathies

D. Neuropathic Arthropathy
  • Ann K. Rosenthal


  • Neuropathic arthropathy, also known as a Charcot joint, is a destructive arthritis characterized by fracture, subluxation, and dislocation of the articular structures in the setting of neurologic damage to the involved joint or limb.

  • Both central (upper motor neuron) and peripheral (lower motor neuron) lesions may lead to the development of neuropathic arthropathy.

  • Diabetic neuropathy is now the most common cause of neuropathic arthropathy. Neuropathic arthropathy occurs in 7.5% of diabetic patients.

  • The pathologic features of Charcot arthropathy include cartilage destruction, bone eburnation, osteophytosis, and loose body formation.

  • Two major theories have been proposed to explain the development of neuropathic arthropathy: the neurovascular theory and the neurotraumatic theory.

  • Neuropathic arthropathy typically presents as an acute or subacute monoarthritis with swelling, erythema, and variable amounts of pain in the affected joint.

  • Two consistent clinical features of neuropathic arthropathy are the presence of a significant sensory deficit and a degree of pain that is less than would be expected considering the amount of joint destruction evident on radiographs.

  • The differential diagnosis of neuropathic arthropathy includes osteomyelitis and other deep tissue infections, fracture, gout, calcium pyrophosphate dihydrate deposition disease, Milwaukee shoulder/knee syndrome, osteonecrosis, and osteoarthritis.

  • ■ Plain radiographs are extremely helpful in making the diagnosis of neuropathic arthropathy. ■ Categorizing the disease into three clinical stages— acute, subacute, and remodeling—is a useful way to organize approaches to therapy.


Diabetic Neuropathy Lower Motor Neuron Destructive Arthritis Basic Calcium Phosphate Crystal Charcot Arthropathy 
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Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Ann K. Rosenthal
    • 1
  1. 1.Department of Medicine, Division of RheumatologyMedical College of Wisconsin/Zablocki VA Medical CenterMilwaukeeUSA

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