How Can I Manage Neuropathy Pain?

Neuropathic arthropathy, also known as neurotrophic arthropathy, neuropathic osteoarthropathy, Charcot arthropathy, is a secondary cause of joint proprioception, pain, loss of protective reactions, and repeated damage. Arthropathy.

Basic Information

nickname: Neurotrophic arthropathy, neuropathic osteoarthropathy, Charcot arthropathy
English name: Neuropathic Arthropathy
Visiting department: Department of Orthopedics, Rheumatology and Immunology

Common locations: Limb joints, spine
Common causes: Joint proprioceptive, pain disorders, loss of protective reactions, repeated injuries
Common symptoms: Early joint swelling, fever, and no pain; late joint dislocation or complete dislocation can occur

Causes of neuropathic arthropathy

It is known that osteoarthropathy can be secondary to central nervous system or peripheral neuropathy. Common diseases include spinal cord disease, syringomyelia, diabetes, spinal cord and peripheral nerve injury, leprosy, multiple sclerosis, spinal membrane bulging, amyloidosis, Congenital anorexia, tuberculosis, tumor invasion of nerves, alcoholism, familial autonomic nerve abnormalities, familial interstitial hypertrophic polyneuropathy, and peroneal muscle atrophy. Spinal cord ridges, syringomyelia, and diabetes are the most common causes of neuropathic joint disease.

Deep pain or postural dysfunction affects the normal protective reflexes of joints, often leading to trauma (especially recurring minor injuries) and fractures that occur around small joints without being noticed. In addition, reflex vasodilation increases bone blood flow, resulting in bone resorption, which can cause fractures, joint damage, and joint repair. The deposition of calcium pyrophosphate or apatite dihydrate in large joints, decreased muscle tone, loosened ligaments, and swelling of the joint capsule due to exudation can accelerate the progress of the disease.

Clinical manifestations of neuropathic arthropathy

It can occur in any joint, including the spine, but is more common in limbs. Due to different neurological diseases, the sites of occurrence are not uniform. For example, joint deformities in patients with hemiplegia are also lateral; syringomyelia joint disease mostly occurs in the upper limbs, and the shoulder and elbow joints are most commonly affected, and a few are found in the temporomandibular, sternocleidomes, wrist and knuckle joints. The lower limbs of the spinal cord are predominant, and the knee joint is most commonly affected, followed by the hip, sacrum, shoulder, elbow, ankle, toe (finger) joint and spine. Diabetic neuropathy mostly occurs in the small joints of the feet, such as the interphalangeal joints. The development of the disease is generally slow, and the course of the disease often exceeds several months or even one year. Typical manifestations are joint swelling, deformity, and instability. Unlike ordinary joint disease, joint deformities and pathological changes are very significant, but joint dysfunction is relatively mild, and sometimes there are abnormal joint activities, such as elbow and knee hyperextension. Early joint swelling, fever, and more pain-free, a few may have persistent pain, the pain intensified during joint movement. In the later stage, due to the relaxation of the joint capsule and ligaments, joint subluxation or complete dislocation occurs.

Neuropathic joint disease examination

Laboratory tests for leprosy neuritis can find evidence of leprosy infection. Laboratory tests of diabetic neuropathy can detect abnormal blood glucose. Spinal syphilis laboratory tests can be positive for specific syphilis tests.

1. X-ray inspection

Early X-rays showed degenerative changes in the joints, and the articular surface was slightly hardened, invaded, and damaged. Articular sclerosis of the affected bone in the late stage of the disease is more obvious, with bone hyperplasia and destruction, periosteal reaction, and joint deformity. Articular surface is irregular, collapsed, joint space narrowed, joint dislocation or subluxation. The soft tissue around the joint is swollen, and irregular calcified spots or bone fragments can be seen in the soft tissue. X-ray findings can be summarized into the following three lesions:

(1) Atrophy or acute type is often mistaken for infection spread or tumor invasion, and joint atrophy often occurs within a few weeks, which is more common in non-weight-bearing areas of the joint. Visible bone destruction and absorption, the transition zone between bone resorption and bone residue is very obvious, just like a knife cut, but no fracture or repair performance.

(2) Hyperplasia or chronic type is more common in joint bearing areas, showing severe osteoarthritis, pathological fractures, giant osteophytes next to joints, joint damage, subluxation or complete dislocation.

(3) The mixed type of atrophy and hyperplasia usually occurs in weight-bearing joints, with progressive destruction and absorption of bone, accompanied by bone hyperplasia and osteophyte formation.

2.CT inspection

CT has the advantage of high resolution, which can better show the structure of the lesion, bone destruction and the condition of adjacent soft tissues. Although X-ray is the preferred method of diagnosis of this disease. However, the combination of CT and X-rays can more clearly show the lesions, help determine the specific range and volume of fluid in the joint cavity, distinguish between increased soft tissue density caused by joint fluid and soft tissue swelling, and distinguish whether free bone mass is in the joint cavity or in the joint cavity. Inside the soft tissue around the joint. For cases where plain radiographs cannot be diagnosed or the extent of the lesion is difficult to determine, CT can be used as an important examination method.

Diagnosis of neuropathic arthropathy

According to the history of the primary disease of the nervous system, joint symptoms that are consistent with the neurological symptoms and signs and the exclusion of other arthritis, such as osteoarthritis, can establish a clinical diagnosis. The primary disease can usually be found, but when about 20% of patients have joint disease, there are no symptoms and signs of the primary disease, and it needs to be distinguished from other arthritis. Neuropathic arthropathy is mostly painless. Although the joint destruction is obvious and deformity occurs, the degree of joint dysfunction is relatively mild. The joint pain, deformity and destruction degree of other arthritis are consistent with joint dysfunction. Since it is clear that the primary disease has guiding significance for clinical treatment, detailed medical history, comprehensive physical examination and laboratory inspection should be asked in order to find out the primary disease. The diagnosis of neurogenic arthropathy mainly addresses two issues, whether it is neurogenic arthropathy, and what kind of neurogenic arthropathy.

Differential diagnosis of neuropathic arthropathy

Differential diagnosis mainly solves the following problems:

1. Whether neurogenic joint disease

According to the basic clinical characteristics of neuropathic arthropathy, especially the primary nervous system lesions before the occurrence of joint disease, clinical diagnosis of neuropathic arthropathy is not difficult. However, there are still about 20% of neuropathic arthropathy in clinical changes. There are no symptoms and signs of primary neuropathy in joint changes. Therefore, it is necessary to identify rheumatoid arthritis, rheumatoid arthritis, metabolism, endocrine, blood, tumors and infections in the diagnosis of joint diseases. This requires investigating the etiology, pathogenesis, predisposition sites, and characteristics of joint lesions that cause joint disease. Neuropathic arthropathy can generally be found in the neurogenic pathogenesis, joint lesions and neuropathy symptoms and signs are consistent, other joint diseases also have corresponding causes. Neuropathic arthropathy is mostly painless, and often has joint deformities, joint damage is obvious, but relatively less joint dysfunction; other joint diseases generally have pain, joint deformity, and the degree of destruction is consistent with joint dysfunction. In addition, neuropathic arthropathy has obvious radiological characteristics, which can be divided into atrophic, proliferative, and atrophic and proliferative mixed types. According to these different characteristics, it can be distinguished from other joint diseases.

2. What kind of neurogenic joint disease

After the diagnosis of neuropathic joint disease, it is necessary to further clarify what kind of neuropathy is the joint disease. This should further investigate the etiology, pathology and clinical characteristics of different neuropathies to determine which neuropathy it belongs to. Such as spinal cord ridge, there is a clear history of syphilis infection, the lesion mainly invades the posterior root and posterior cord of the lumbosacral spinal cord, lower limb lightning-like pain and progressive sensory ataxia, and serum and cerebrospinal fluid Kanghua chemical reaction. Syringomyelia is chronic degeneration, softening, and cavitation of the spinal cord. It mainly invades the neck, the posterior horn of the thoracic spine, or near the central canal. Magnetic resonance (MRI) examination can reveal a parenchymal cavity lesion in the spinal cord. Diabetic neuropathy, in addition to sensory and motor neurological disorders, may have a history of diabetes, elevated blood sugar, and urine glucose positive.

Neuropathic Arthropathy Treatment

Conservative treatment

The main focus is to strengthen joint protection, such as local brake support.

Symptomatic treatment

Anti-inflammatory and analgesics can be used when the pain is severe, but such drugs should be used in small amounts for long-term use, so as not to accelerate joint destruction. On the one hand, these drugs reduce joint swelling and pain, and protector muscle spasm, and thus suffer from excessive stress and abrasion trauma; on the other hand, these drugs can inhibit the production of prostaglandins and hinder the repair of subchondral bone.

Intra-articular injection of hormonal drugs is not recommended for multiple use. Such drugs have a significant effect of reducing inflammation and relieving symptoms. As a result, joint activity of patients increases and joint wear and damage is accelerated.

3. Etiology treatment

Find out the cause first, and then treat the cause. Diabetes is controlled by diet and oral hypoglycemic drugs, which not only treat the primary disease, but also improve joint symptoms. Such as syringomyelia, oral nuclide ¹³¹ I, or deep X-ray irradiation of the hollow segment, a few feasible hollow incision and drainage fluid. The spinal cord is treated with syphilis for syphilis.

4. Joint disease treatment

There is no specific treatment, and the prognosis varies with the severity of the disease and the response to surgical treatment. The principle of treatment is to reduce weight bearing, protect and stabilize joints.

5. Treatment of Osteoarthritis itself

The principle of treatment of neurogenic osteoarthropathy is to reduce weight bearing, protect and stabilize joints. Consider amputation.

6. Surgical treatment

Surgical treatments such as arthrodesis or arthroplasty, total joint replacement, etc. In rare cases, amputation may be considered for severe cases of infection, progressive ulcers, and joint damage.

Prognosis of neuropathic arthropathy

The development of the disease is generally slow, and the course of the disease often exceeds several months or even one year. Prognosis varies with disease severity and responsiveness to surgical treatment.