neuropathic joint disease

WordNet

1. come into the company of; "She joined him for a drink"
2. cause to become joined or linked; "join these two parts so that they fit together" (同)bring together
3. make contact or come together; "The two roads join here" (同)conjoin
4. become part of; become a member of a group or organization; "He joined the Communist Party as a young man" (同)fall_in, get together
5. united or combined; "a joint session of Congress"; "joint owners"
6. marijuana leaves rolled into a cigarette for smoking (同)marijuana cigarette, reefer, stick, spliff
7. a disreputable place of entertainment
8. junction by which parts or objects are joined together
9. (anatomy) the point of connection between two bones or elements of a skeleton (especially if it allows motion) (同)articulation, articulatio
10. provide with a joint; "the carpenter jointed two pieces of wood" (同)articulate
11. affecting or involving two or more; "joint income-tax return"; "joint ownership"
12. fasten with a joint
13. fit as if by joints; "The boards fit neatly"
14. involving both houses of a legislature; "a joint session of Congress"
15. separate (meat) at the joint
16. an impairment of health or a condition of abnormal functioning
17. caused by or altered by or manifesting disease or pathology; "diseased tonsils"; "a morbid growth"; "pathologic tissue"; "pathological bodily processes" (同)morbid, pathologic, pathological

PrepTutorEJDIC

1. 〈二つ以上のもの〉‘を'『つなぐ』,結合する《+『名』+『together』(『up』)》;(…に)…‘を'つなぐ《+『名』+『to』(『onto』)+『名』》 / (線などで)〈二つ以上のもの〉‘の'間を結ぶ(つなぐ)《+『名』+『by』(『with』)+『名』》 / (友情・結婚などで)〈人〉‘を'結びつける《+『名』+『in』+『名』》 / 〈川・道などが〉…‘と'いっしょになる,合流する / 〈会など〉‘に'『加入する』 / (…で)〈人〉‘の'『仲間に入る』,‘と'いっしょになる《+『名』〈人〉+『in』(『for』)+『名』,+『名』〈人〉+『in』do『ing』》 / (…に)『加わる』《+『in』+『名』〈事〉/+『in』 『with』+『名』〈人〉》 / (人と…を)『ともにする』《+『with』+『名』〈人〉+『in』+『名』(doing)》 / 〈川・道などが〉『いっしょになる』,合流する / 接合箇所(点,面,線);継ぎ目
2. 『関節』 / 『継ぎ目』,接合箇所,合わせ目 / 継ぎ目と継ぎ目の間の部分,節 / (二つの部分を継いだり支えたりするのに用いる)継ぎ手,ジョイント / (枝や葉の)つけ根,節 / (骨付きの)肉の大切り身 / 《俗》安酒場,とばく宿,アヘン窟(くつ) / 『共同の』,共有の;連帯の,連合の / 両院合同の;二院制議会の両院の / …‘を'継ぎ合わせる;…‘を'継ぎ目(関節)でつなぐ / …‘を'継ぎ目で分ける;〈鳥・肉など〉‘を'関節で切り分ける
3. (体の)『病気』,疾患 / (精神・道徳などの)病気,病弊
4. 女性の話術芸人 =diseur
5. 病気にかかった / 病的な,不健全な(morbid)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/11/16 03:44:57」(JST)

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"Charcot joint disease" redirects here. For other uses, see Charcot disease.

Neuropathic joint disease
A 68-year-old diabetic female on dialysis presented with a chronic right heel ulcer (3.4 cm X 3.1 cm) of greater than 3 months duration. Photograph of the wound after thorough wound bed preparation over the course of 2 weeks.
Classification and external resources
Specialty	rheumatology
ICD-10	M14.6
ICD-9-CM	713.5
DiseasesDB	2344
eMedicine	orthoped/381 radio/476, article/1234293

Neuropathic arthropathy (or neuropathic osteoarthropathy), also known as Charcot joint (often "Charcot foot"), refers to progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity. Onset is usually insidious.

If this pathological process continues unchecked, it can result in joint deformity, ulceration and/or superinfection, loss of function, and in the worst-case scenario, amputation or death. Early identification of joint changes is the best way to limit morbidity.

Pathogenesis

Any condition resulting in decreased peripheral sensation, proprioception, and fine motor control:

• Diabetes mellitus neuropathy (the most common in the U.S. today, resulting in destruction of foot and ankle joints), with Charcot joints in 1/600-700 diabetics. Related to long-term poor glucose control.
• Alcoholic neuropathy
• Cerebral palsy
• Leprosy
• Syphilis (tabes dorsalis), caused by the organism Treponema pallidum
• Spinal cord injury
• Myelomeningocele
• Syringomyelia
• Intra-articular steroid injections
• Congenital insensitivity to pain
• Peroneal muscular atrophy

Underlying mechanisms

• Two primary theories have been advanced:
  • Neurotrauma: Loss of peripheral sensation and proprioception leads to repetitive microtrauma to the joint in question; this damage goes unnoticed by the neuropathic patient, and the resultant inflammatory resorption of traumatized bone renders that region weak and susceptible to further trauma. In addition, poor fine motor control generates unnatural pressure on certain joints, leading to additional microtrauma.
  • Neurovascular: Neuropathic patients have dysregulated autonomic nervous system reflexes, and de-sensitized joints receive significantly greater blood flow. The resulting hyperemia leads to increased osteoclastic resorption of bone, and this, in concert with mechanical stress, leads to bony destruction.

In reality, both of these mechanisms probably play a role in the development of a Charcot joint.

Joint involvement

Diabetes is the foremost cause in America today for neuropathic joint disease, and the foot is the most affected region. In those with foot deformity, approximately 60% are in the tarsometatarsal joints (medial joints affected more than lateral), 30% Metatarsophalangeal joints and 10% have ankle disease. Over half of diabetic patients with neuropathic joints can recall some kind of precipitating trauma, usually minor.

Patients with neurosyphilis tend to have knee involvement, and patients with syringomyelia of the spinal cord may demonstrate shoulder deformity.

Hip joint destruction is also seen in neuropathic patients.

Symptoms and signs

Oblique view X-ray in a 45-year-old male diabetic revealed a divergent, Lisfranc dislocation of the first metatarsal with associated lesser metatarsal fractures.

The same 45-year-old man with diabetes mellitus presented with a diffusely swollen, warm and non-tender left foot due to Charcot arthropathy. There are no changes to the skin itself.

The clinical presentation varies depending on the stage of the disease from mild swelling to severe swelling and moderate deformity. Inflammation, erythema, pain and increased skin temperature (3–7 degrees Celsius) around the joint may be noticeable on examination. X-rays may reveal bone resorption and degenerative changes in the joint. These findings in the presence of intact skin and loss of protective sensation are pathognomonic of acute Charcot arthropathy.

Roughly 75% of patients experience pain, but it is less than what would be expected based on the severity of the clinical and radiographic findings.

Clinical findings

Clinical findings include erythema, edema and increased temperature in the affected joint. In neuropathic foot joints, plantar ulcers may be present. Note that it is often difficult to differentiate osteomyelitis from a Charcot joint, as they may have similar tagged WBC scan and MRI features (joint destruction, dislocation, edema). Definitive diagnosis may require bone or synovial biopsy.

Radiologic findings

First, it is important to recognize that two types of abnormality may be detected. One is termed atrophic, in which there is osteolysis of the distal metatarsals in the forefoot. The more common form of destruction is hypertrophic joint disease, characterized by acute peri-articular fracture and joint dislocation. According to Yochum and Rowe, the "6 D's" of hypertrophy are:

1. Distended joint
2. Density increase
3. Debris production
4. Dislocation
5. Disorganization
6. Destruction

The natural history of the joint destruction process has a classification scheme of its own, offered by Eichenholtz decades ago:

Stage 0: Clinically, there is joint edema, but radiographs are negative. Note that a bone scan may be positive before a radiograph is, making it a sensitive but not very specific modality.

Stage 1: Osseous fragmentation with joint dislocation seen on radiograph ("acute Charcot").

Stage 2: Decreased local edema, with coalescence of fragments and absorption of fine bone debris

Stage 3: No local edema, with consolidation and remodeling (albeit deformed) of fracture fragments. The foot is now stable.

Destroyed Tarsometatarsal joints in the medial left foot, with fracture and dislocation of fragments; these are classic findings. Also note loss of the foot arch and acquired flat foot (pes planus) deformity.

Atrophic features:

1. "Licked candy stick" appearance, commonly seen at the distal aspect of the metatarsals
2. Diabetic osteolysis
3. Bone resorption

Treatment

Once the process is recognized, it should be treated via the VIPs — vascular management, infection management and prevention, and pressure relief. Aggressively pursuing these three strategies will progress the healing trajectory of the wound. Pressure relief (off-loading) and immobilization with total contact casting (TCC) are critical to helping ward off further joint destruction.

TCC involves encasing the patient’s complete foot, including toes, and the lower leg in a specialist cast that redistributes weight and pressure in the lower leg and foot during everyday movements. This redistributes pressure from the foot into the leg, which is more able to bear weight, to protect the wound, letting it regenerate tissue and heal. TCC also keeps the ankle from rotating during walking, which prevents shearing and twisting forces that can further damage the wound. TCC aids maintenance of quality of life by helping patients to remain mobile.

There are two scenarios in which the use of TCC is appropriate for managing neuropathic arthropathy (Charcot foot), according to the American Orthopaedic Foot and Ankle Society. First, during the initial treatment, when the breakdown is occurring, and the foot is exhibiting edema and erythema; the patient should not bear weight on the foot, and TCC can be used to control and support the foot. Second, when the foot has become deformed and ulceration has occurred; TCC can be used to stabilize and support the foot, and to help move the wound toward healing.

Walking braces controlled by pneumatics are also used. Surgical correction of a joint is rarely successful in the long-term in these patients. However, off-loading alone does not translate to optimal outcomes without appropriate management of vascular disease and/or infection. Duration and aggressiveness of offloading (non-weight-bearing vs. weight-bearing, non-removable vs. removable device) should be guided by clinical assessment of healing of neuropathic arthropathy based on edema, erythema, and skin temperature changes. It can take 6–9 months for the edema and erythema of the affected joint to recede.

Outcome

Outcomes vary depending on the location of the disease, the degree of damage to the joint, and whether surgical repair was necessary. Average healing times vary from 55–97 days depending on location. Up to 1–2 years may be required for complete healing.

References

Further reading

• Neuropathic osteoarthropathy by Monica Bhargava, M.D., University of Washington Department of Radiology
• John R. Crockarell; Daugherty, Kay; Jones, Linda Winstead; Frederick M. Azar; Beaty, James H; James H. Calandruccio; Peter G. Carnesale; Kevin B. Cleveland; Andrew H. Crenshaw (2003). Campbell's Operative Orthopedics (10th ed.). Saint Louis: C.V. Mosby. ISBN 0-323-01248-5. 
• Gupta R (November 1993). "A short history of neuropathic arthropathy". Clin. Orthop. Relat. Res. (296): 43–9. PMID 8222448. 
• Sommer TC, Lee TH (November 2001). "Charcot foot: the diagnostic dilemma". Am Fam Physician 64 (9): 1591–8. PMID 11730314. 

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• Imaging in Neuropathic Arthropathy (Charcot Joint): Overview ...

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• Charcot Joint Disease (Neuroarthropathy) : Foot and Ankle ...

Description Charcot joint disease was given its name by the French neurologist Jean-Marie Charcot in 1868. He noted a bizarre pattern of bone destruction in patients with tertiary syphilis and absent sensation. In 1936, William Jordan ...

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★リンクテーブル★

リンク元	「Charcot's joint」
関連記事	「disease」「join」「neuropathic」「joint disease」「joint」

「Charcot's joint」

　　[★]

関

neuropathic joint disease

「disease」

　　[★]

• n.

疾患：illnessより厳密な概念。「ある臓器に明確な障害が確認され、それによって症状が出ているとはっきり説明できる場合」 (PSY.9)

特定の原因、病態生理、症状、経過、予後、病理組織所見が全てそろった場合 (PSY.9)

• something that is very wrong with people's attitudes, way of life or with society.

関

ail、ailment、disease entity、disorder、ill、illness、malady、sick、sickness

• 注意

disease ≠ illness ≠ disorder

　 　 　

「join」

　　[★]

• v.

• 連結する、結合する、参加する

関

associate、attend、bind、binding、bond、bonding、catenate、combine、concatenation、conjoin、conjugate、conjugation、conjunction、connect、connection、couple、dock、engage、engagement、juncture、ligate、ligation、link、linkage、participation、symphysial、union

PHP

implode() のエイリアス

　 　 　 　 　

「neuropathic」

　　[★]

• adj.

• 神経障害性の、神経障害の、ニューロパチーの、神経因性の

関

nerve damage、nervous system disorder、neurogenic、neurologic deficit、neurologic disorder、neurological deficit、neurological disorder、neuropathy

「joint disease」

　　[★]

• 関節疾患、関節症

関

arthropathy、arthrosis

「joint」

　　[★]

• n.

• 関節