neuropathic arthropathy
Introduction
Introduction to neuropathic joint disease Neurological arthropathy (NA), also known as Charcot joint, is a secondary joint disease caused by joint proprioception, pain disorder, loss of protective response, and repeated damage. basic knowledge The proportion of illness: 0.3% Susceptible people: no special people Mode of infection: non-infectious Complications: septic arthritis
Cause
Causes of neuropathic joint disease
(1) Causes of the disease
It is known that both central nervous system and peripheral neuropathy can be secondary to osteoarthrosis, common with spinal cord spasm, syringomyelia, diabetes, spinal cord and peripheral nerve injury, leprosy, multiple sclerosis, spinal cord bulging, amyloidosis, congenital Absence of pain, tuberculosis, tumor invasion, alcoholism, familial autonomic abnormalities, familial interstitial hypertrophic neuropathy, patellar muscular atrophy, etc. Among them, spinal cord spasm, syringomyelia and diabetes are the most common the reason.
(two) pathogenesis
Due to neurological dysfunction, deep sensation and analgesia, the position can not be adjusted consciously, the joint is repeatedly subjected to mechanical damage, and local neuro-vascular dystrophies and maladaptation are common, causing degenerative destruction of joints and soft tissues. The pathogenesis of NA is not yet It is clear that joint damage is generally thought to be caused by neuropathy, but since Charcot described the disease, it has supported the neurovascular mechanism, the pathogenesis of neurotrophic disorders.
1. The injury states that the pathological changes of the joint are the result of painless repeated injury. However, the clinical and radiological manifestations of NA often suggest that in addition to the cause of the injury, there are other reasons. Charcot's original description emphasizes the bone caused by neurodegeneration. And joint dystrophy, suggesting that sympathetic nerves cause changes in bone and joint blood flow, leading to persistent hyperemia and bone resorption of bones and joints. Therefore, the true pathogenesis of NA may be neurological bone and joint damage and neurovascular dystrophy. The combination of people.
2. Due to neurological dysfunction, deep sensation and analgesia, the position can not be adjusted consciously, the joint is susceptible to repeated mechanical damage, combined with local soft tissue and bone and joint neurovascular dystrophy, poor metabolism, etc., resulting in damaged bone surface Bone and soft tissue destruction and degeneration, due to different body reactions, bone atrophy and sparse, bone fracture or absorption; more is new bone hyperplasia, osteophyte formation, osteophyte fracture and shedding to form debris free body Intra-articular hemorrhage, exudate causes joint swelling, joint capsule hypertrophy; due to relaxation of the joint capsule and surrounding ligaments, the entire joint can be broken, the joint subluxation, dislocation or complete disintegration.
Prevention
Neuropathic joint disease prevention
1. Prevention is the best treatment. Diabetes patients should pay attention to the foot and the sputum, and deal with the minor trauma in these parts in time. Effective control of blood sugar can reduce diabetic neuropathy, and then reduce the incidence of this disease.
2. Strengthen the early treatment of syphilis to prevent the occurrence of this disease.
Complication
Neuropathic joint disease complications Complications septic arthritis
Complications include septic arthritis and compression of adjacent tissue structures (such as blood vessels, nerves or spinal cord). When there is generalized symptoms such as general discomfort, fever, etc., which are difficult to explain with local signs, the synovial fluid should be extracted for culture.
Symptom
Symptoms of neuropathic joint disease Common symptoms Joint pain Joint deformity Persistent pain Joint swelling
It can occur in any joint including the spine, but it is more common in the joints of the extremities. Due to different neurological diseases, the predilection sites are not consistent. For example, the joint deformity of the patients with hemiplegia is also paralyzed. The syringomyelia joint disease occurs mostly in the upper limbs and shoulders. And elbow joints are most often involved, a few are found in the jaw, chest lock, wrist and knuckle, etc., the spinal cord is mainly in the lower limbs, the knee is most often involved, followed by the hip, humerus, shoulder, elbow, ankle, toe (referring to Joints and spine, diabetic neuropathy mostly occurs in the small joints of the feet such as the interphalangeal joints. The development of the lesions is generally slow, and the course of disease often exceeds months or even 1 year. The typical manifestations are joint swelling, deformity and instability, and general The different characteristics of joint disease are joint deformity and pathological changes are very significant, but joint dysfunction is relatively light, sometimes there are joint abnormal activities such as elbow and knee joint overextension, early joint swelling, fever, and more pain, a few may have Persistent pain, increased pain during joint movement, and late joint dislocation or complete dislocation due to relaxation of the joint capsule and ligament.
Examine
Examination of neuropathic joint disease
Evidence of leprosy infection can be found in laboratory tests for leprosy neuritis. Blood glucose abnormalities can be detected in laboratory tests for diabetic neuropathy. Laboratory tests for spinal syphilis can be found to be positive for syphilis specific tests.
X-ray inspection
The early X-ray showed degenerative changes of the joints, mild sclerosis of the joint surface, erosion and destruction, and the joint end-hardening of the affected bone was more obvious in the late stage of the lesion, with bone hyperplasia, destruction, periosteal reaction, joint deformity, irregular articular surface, Collapse, joint space narrowing, joint dislocation or subluxation, soft tissue swelling around the joint, irregular calcified plaque or broken bone fragments in the soft tissue.
X-ray findings can be summarized into the following three lesions:
(1) atrophy or acute type: often mistaken for infection spread or tumor invasion, often rapid joint atrophy within a few weeks, more common in the non-weight-bearing area of the joint, visible bone destruction and absorption, bone resorption and bone The transition zone between the residues is very obvious, just like a knife cut, but without fractures or repairs.
(2) hyperplasia or chronic type: more common in the weight-bearing area of the joint, showing severe osteoarthritis, pathological fractures, massive osteophytes around the joints, joint damage, subluxation or complete dislocation.
(3) Mixed type of atrophy and hyperplasia: usually occurs in weight-bearing joints, progressive destruction and absorption of bone, accompanied by bone hyperplasia and osteophyte formation.
2. CT examination
CT has the advantage of high resolution, which can better display the structure of the lesion, bone destruction and adjacent soft tissue. Although X-ray is the preferred method for the diagnosis of this disease, CT and X-ray combination can clearly show the lesion. Help to determine the specific range and fluid volume of joint fluid, distinguish the increase of soft tissue density caused by joint effusion and soft tissue swelling, distinguish whether the free bone is in the joint cavity or soft tissue around the joint, can not be diagnosed or difficult to determine for the plain film In cases of lesions, CT can be used as an important means of examination.
Diagnosis
Diagnosis and diagnosis of neuropathic joint disease
diagnosis
According to the history of the primary disease of the nervous system, joint symptoms that are consistent with the symptoms and signs of the nervous system, and other arthritis such as osteoarthritis are excluded, and a clinical diagnosis can be established. The primary disease can be generally found, but about 20%. When the patient has a lesion in the joint, there are no symptoms and signs of the primary disease, and it needs to be differentiated from other arthritis: NA is mostly painless, although the joint damage is obvious and deformed, but the joint dysfunction is mild; other joints Inflammatory joint pain, deformity, and degree of destruction are consistent with joint dysfunction. Because the primary disease is instructive for clinical treatment, detailed medical history, comprehensive physical examination and laboratory examination should be conducted to find the primary disease, neurogenic source. The diagnosis of sexual joint disease mainly solves two problems, whether it is neurogenic joint disease or what kind of neurogenic joint disease.
Differential diagnosis
The differential diagnosis mainly solves the following problems.
1. Whether neurogenic joint disease
According to the clinical basic characteristics of NA, especially the primary neurological lesions before the occurrence of joint lesions, clinical diagnosis of NA is not difficult, but in the clinical still about 20% of NA in the joint changes in fashion without primary neuropathy symptoms And signs, so in the diagnosis need to identify rheumatism, rheumatoid, metabolism, endocrine, blood, tumors and infections and other related joint diseases, which need to investigate the cause of joint disease, pathogenesis, predilection sites and joint lesions Characteristics, NA can generally find the primary neuropathy, joint lesions and neuropathy symptoms and signs are consistent, other joint diseases also have corresponding causes, NA is mostly painless, and often have joint deformities, joint damage is obvious, However, the joint dysfunction is relatively light; other joint diseases generally have pain, joint deformity, and the degree of damage is consistent with joint dysfunction. In addition, NA has obvious radiological characteristics, which can be divided into atrophic type, proliferative type and atrophy and hyperplasia. Type, according to these different characteristics can be identified with other joint diseases.
2. What kind of neurogenic joint disease
After the diagnosis of NA disease, it is necessary to further clarify the nature of the joint disease caused by neuropathy. This should further investigate the etiology, pathology and clinical features of different neuropathies to determine which neuropathy, such as spinal cord hernia, has a clear history of syphilis infection. The lesion mainly invades the posterior and posterior cord of the lumbosacral spinal cord, the lower limbs are lightning-like pain and progressive sensory ataxia, and the serum and cerebrospinal fluid are positive for Kanghuahua. The syringomyelia is chronic degeneration of the spinal cord, softening and cavity formation. Invasion of the neck, the posterior horn of the thoracic cord or the vicinity of the central canal, manifested as segmental pain and temperature loss, tactile presence, so-called sensory separation, sometimes visible local muscle atrophy, nuclear magnetic resonance (MRI) examination can be found in the spinal cord long-form cavity lesions Diabetic neuropathy, in addition to sensory and motor neurological disorders, may have a history of diabetes, elevated blood sugar, and positive urine sugar.
