Sequeira W
Division of Rheumatology, Cook County Hospital, Chicago, Illinois 60612.
Clin Exp Rheumatol. 1994 May-Jun;12(3):325-37.
Neuropathic arthritis is a destructive arthropathy frequently associated with loss of proprioception. A third of patients, however, may have no demonstrable neurological deficit. Patients with diabetes, syphilis, syringomyelia and other neuropathies are particularly prone to developing this joint disease. The diagnosis of Charcot's joints should be considered in anyone who develops what appears to be a severe osteoarthritis or a transverse fracture of the tibia or fibula after minor trauma. Scoliosis with particularly destructive changes on radiography should prompt a search for syringomyelia or syphilis. The most common radiographic abnormalities are those of distension in 3D (Dislocation, Destruction and Degeneration). An atrophic form with resorption of the proximal humerus, most frequently described in syringomyelia, has been observed in diabetes. Loss of the distal end of the clavicle has not been described before in the neuropathies. These changes coupled with speckled calcification or shards of bone in the periarticular soft tissue confirm the diagnosis. Infection and CPPD crystal disease can be difficult to exclude. The joint fluid may be inflammatory and infection may be a complication. Treatment includes anti-inflammatories and splinting. Indications for surgery are limited.
神经性关节炎是一种破坏性关节病，常与本体感觉丧失相关。然而，三分之一的患者可能没有明显的神经功能缺损。糖尿病、梅毒、脊髓空洞症和其他神经病变患者尤其容易患上这种关节疾病。对于任何在轻微创伤后出现看似严重骨关节炎或胫骨或腓骨横行骨折的人，都应考虑夏科关节的诊断。脊柱侧弯在影像学上有特别破坏性的改变，应促使医生寻找脊髓空洞症或梅毒。最常见的影像学异常是三维膨胀（脱位、破坏和退变）。糖尿病患者中观察到一种萎缩型，表现为肱骨近端吸收，这种情况在脊髓空洞症中最为常见。锁骨远端缺失在神经病变中此前尚未有过描述。这些变化加上关节周围软组织中的斑点状钙化或骨碎片可确诊。感染和焦磷酸钙晶体病可能难以排除。关节液可能有炎症，感染可能是一种并发症。治疗包括使用抗炎药和夹板固定。手术指征有限。
