Neuropathic arthritis is a condition that affects the joints and nerves. It can cause joint deformities and damage, most commonly in the feet and ankles.
Also called Charcot joint or neuroarthropathy, neuropathic arthritis is a complex and debilitating condition.
Unlike other types of arthritis, such as osteoarthritis or rheumatoid arthritis, this condition involves nerve dysfunction and joint inflammation. This unique combination sets it apart from other arthritis types and presents specific challenges in diagnosis and management.
Researchers do not understand the exact causes of neuropathic arthritis. However, doctors often associate it with underlying conditions affecting the nerves, such as diabetes or spinal cord injuries. These medical conditions can lead to nerve damage, impairing the ability to feel pain or joint damage.
This article explores neuropathic arthritis, including its causes and how doctors diagnose and treat it.
Neuropathic arthritis is a distinct form of arthritis affecting joints and nerves. It leads to a combination of joint inflammation and nerve dysfunction.
This condition can occur when the nerves that transmit pain signals and sensory feedback to the joints are damaged or impaired.
As a result, individuals with neuropathic arthritis may not experience the typical pain associated with joint injuries or inflammation. This lack of pain sensation can lead to continued use of the affected joint, resulting in progressive joint damage, deformity, and functional impairment.
Individuals with underlying conditions that affect the nerves — such as diabetes, syphilis, or peripheral neuropathy — are more likely to have neuropathic arthritis. These underlying conditions can contribute to nerve damage and disrupt the typical sensory perceptions of pain and joint injury.
What joints does it involve?
The joints that neuropathic arthritis most commonly affects bear weight and experience repetitive stress, such as the feet and ankles. Over time, the joints can become swollen, red or discolored, and warm to the touch.
Without proper intervention, the bones in the affected joints may weaken, collapse, and ultimately lead to a characteristic deformity some people call “rocker-bottom foot.”
In neuropathic arthritis, the typical pain signals accompanying joint damage may be absent.
However, there are several signs and symptoms that individuals may experience,
- joint swelling and warmth on one side
- joint instability
- walking difficulties
- deformity
- loss of sensation
- a limited range of motion
It is important to note that symptoms can vary among individuals, and the progression of neuropathic arthritis can differ for each person. Therefore, prompt medical evaluation is essential if a person has any signs or symptoms.
Besides nerve damage from underlying medical conditions, the
- Inflammatory disorders: Certain conditions, such as rheumatoid arthritis, gout, or lupus, can lead to joint inflammation and subsequent nerve dysfunction, potentially contributing to neuropathic arthritis.
- Trauma: Joint injuries, fractures, or repeated trauma to the joints can damage the nerves and initiate neuropathic arthritis.
- Infection: Infections that affect the joints, such as septic arthritis or osteomyelitis, can cause inflammation and subsequent nerve damage, leading to neuropathic arthritis.
Neuropathic arthritis typically progresses through stages as the condition advances. However, not all individuals progress through all stages, and the rate of progression can vary.
The table below outlines the
| Stage | Characteristics |
| Stage 0 | The joint is red, hot, and swollen but has no deformities. X-rays are normal. |
| Stage 1: Development and destruction | The joint is still swollen and hot. Also, X-rays show bony debris at joints and deformities. |
| Stage 2: Coalescence | There is less inflammation in the joint, but X-rays show worsening stage 1 features. The fragmented bones within a joint begin to fuse, and the bony tissue at the ends of the fragmented bones becomes hard and thick. |
| Stage 3: Consolidation | The inflammation resolves, but there are changes to the foot shape due to bony remodeling. This can create new pressure points, potentially leading to ulcers. |
Diagnosing neuropathic arthritis involves a comprehensive evaluation to rule out other conditions that cause similar symptoms, for example, gout.
It consists of
- Medical history and physical examination: The doctor reviews the person’s medical history, including any underlying conditions or previous injuries. A physical exam helps assess the joint in terms of appearance, range of motion, and signs of inflammation.
- Imaging studies: X-ray, MRI, or CT scans can evaluate joint damage, bone abnormalities, or deformities associated with neuropathic arthritis.
- Nerve function tests: Nerve conduction studies or electromyography allow doctors to assess nerve function and detect any abnormalities or damage in the affected area.
- Laboratory tests: Blood tests help assess underlying conditions contributing to neuropathic arthritis, such as diabetes or inflammatory markers.
- Joint fluid analysis: If there is joint inflammation, the doctor may perform a joint aspiration to collect fluid for analysis, helping rule out other conditions and evaluate for infection or inflammation.
Generally, treatment for neuropathic arthritis aims to:
- alleviate symptoms
- prevent further joint damage
- improve overall joint function
- treat any underlying conditions
Some treatment approaches
Immobilization and support
Orthopedic devices — such as braces, splints, or casts — help stabilize and protect the affected joint, reducing further damage and promoting healing.
A person may also need assistive devices, such as canes or walkers, to improve mobility and reduce joint stress.
Medications
Doctors may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain-relieving medications to manage pain, reduce inflammation, and improve joint function. They may also recommend bisphosphonates and calcitonin supplements to reduce bone loss.
Learn more about medications for arthritis.
Physical therapy
A customized physical therapy program can help improve joint strength, stability, and range of motion. Physical therapists may also suggest exercises to maintain joint health and minimize complications.
Learn more about physical therapy for arthritis pain.
Surgery
In severe cases of neuropathic arthritis, where a person has significant joint damage and instability, a doctor may recommend surgery. Joint fusion, reconstruction, or replacement procedures can restore joint function and stability.
Learn more about surgery for arthritis.
Neuropathic arthritis is a complex condition affecting both the joints and nerves. It leads to joint deformities and damage, most commonly in weight-bearing joints such as the feet and ankles.
Doctors associate neuropathic arthritis with underlying conditions affecting the nerves, such as diabetes or spinal cord injuries. Therefore, treatment aims to address the underlying cause, relieve inflammation, and prevent further joint destruction. It may involve supportive devices, medications to prevent bone loss, and surgery.
Early intervention, appropriate management, and regular follow-up can help minimize joint damage and optimize quality of life.