Department of Rheumatology, Charles Nicolle Hospital, 1007, Tunis, Tunisia.
University of Tunis El Manar, Tunis, Tunisia.
Eur Spine J. 2022 Oct;31(10):2733-2752. doi: 10.1007/s00586-022-07299-4. Epub 2022 Jul 16.
Neuropathic arthropathy (NA) of the shoulder is a chronic progressive process characterized by joint destruction in the presence of a neurosensory deficit. Syringomyelia, a spinal cord disease, is the leading cause of NA in the upper extremity.
We present a systematic review of NA with syringomyelia cases alongside a case report of an adult with NA of the shoulder that occurs a few 4 years after a revelation and surgical management of a Chiari malformation with syringomyelia.
A systematic review was conducted following PRISMA guidelines. A PubMed, Scopus, Isiknowledge, and manual search through references of relevant publications were used to identify all published case reports of NA. Data were collected from each case report on patient characteristics.
The systematic review identified 56 publications and 85 patients (including ours): nearly the same number of males (n = 41) and females (n = 44). The mean age was 50,69. Presentations included reduction of mobility (n = 66), swelling (n = 61) and sensory disorder (n = 63). The pain was absent in 41 cases. In the majority of reported cases 56 (65.1%), syringomyelia was revealed by neuropathic arthropathy, and eleven patients (12.9%) had a history of syringomyelia. Treatment was categorized into non-operative management (37[43.5%]), operative management (27[31.7%]). Following-up was non-reported in 31 (36%) cases. Improvement was reported more with patients who underwent a surgical approach than medical one 28.5% versus 8.1%.
Physicians need to be more aware of this destructive joint disease, rare, and often misdiagnosed. Also, it is imperative to integrate clinical, pathological, and imaging findings for accurate diagnosis and for delivering appropriate therapy.
神经性关节病（NA）是一种慢性进行性疾病，其特征是在存在神经感觉缺损的情况下出现关节破坏。脊髓空洞症是上肢 NA 的主要原因。
我们对伴有脊髓空洞症的 NA 病例进行了系统回顾，并报告了一例成人肩部 NA 的病例，该病例发生在脊髓空洞症伴 Chiari 畸形的发现和手术治疗后 4 年。
按照 PRISMA 指南进行系统回顾。通过 PubMed、Scopus、Isiknowledge 和相关出版物参考文献的手动搜索，对所有已发表的 NA 病例报告进行了检索。从每个病例报告中收集患者特征的数据。
系统回顾确定了 56 篇文献和 85 例患者（包括我们的病例）：男性（n=41）和女性（n=44）数量几乎相同。平均年龄为 50.69 岁。表现包括活动度降低（n=66）、肿胀（n=61）和感觉障碍（n=63）。41 例患者无疼痛。在大多数报道的病例中，56 例（65.1%）是由于神经性关节病而发现脊髓空洞症，11 例（12.9%）有脊髓空洞症病史。治疗分为非手术治疗（37 例[43.5%]）和手术治疗（27 例[31.7%]）。31 例（36%）未报告随访情况。接受手术治疗的患者比接受药物治疗的患者改善更多，分别为 28.5%和 8.1%。
医生需要更加意识到这种破坏性关节疾病，它很罕见，且经常被误诊。此外，整合临床、病理和影像学表现对于准确诊断和提供适当的治疗至关重要。
