Pseudoseptic arthritis: an unusual presentation of neuropathic arthropathy

Article Abstract:

Septic arthritis is an arthritic condition that arises from infection of synovial (joint) tissues by bacteria or other agents. A case is described of a 49-year-old man who had a condition that mimicked septic arthritis, but was caused by neuropathic arthropathy, a joint disorder in which nerve damage and loss of sensation lead to overuse and repetitive joint injury. The patient had syringomyelia, a fluid-filled cavity within the spinal cord, which contributed to tingling and numbness in the hand, numbness and weakness in the arm, and muscle atrophy. Neuropathic arthropathy occurs in up to 30 percent of patients with syringomyelia, most often involving the shoulder. Diagnosis of the joint problem was delayed by seven months, as the shoulder swelling, although massive, was painless. Many details of this patient's case are typical. Severe destruction of the shoulder developed rapidly, within one month. Neuropathic arthropathy involving the shoulder is thought to involve nerve loss, which then leads to decreased blood flow to bone, and bone resorption (loss of calcium and bone structure). The case is unusual, however, regarding the high level of inflammation and high numbers of white blood cells that were present in the synovial fluid. Bacterial infections were ruled out. This type of inflammatory phase may be a more common feature of early neuropathic arthropathy than realized. Alternatively, it might have been provoked by high synovial fluid levels of fat particles, possibly generated from red blood cells or the breakdown of bone marrow. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Abnormalities, Physiological aspects, Spinal cord, Charcot joints, Charcot's joints

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Synovial irritants: crystals, microbes and others - their implications for diagnosis, pathogenesis and therapy

Article Abstract:

An overview is presented of the types of foreign matter that can cause inflammation within joints together with their diagnosis, how they cause disease, and treatments. Crystals may be deposited within the joint, the most common of which is urate crystals, the cause of gout. Treatment is available to dissolve urate crystals and the crystal deposits that sometimes occur with kidney dialysis but not other types of crystals. Joint inflammation resulting from infection may be difficult to diagnose with without biopsy of the joint membrane and specialized laboratory techniques. The most common entry is via the circulation. Pathogens may cause inflammation by infecting cells, producing toxins, or triggering an immune response. Antibiotics and drainage usually effect cure, although some pathogens are recalcitrant. Artificial joints can introduce foreign bodies through wear. Materials should be used that do not create this problem.

Joints, Joints (Anatomy), Causes of, Inflammation, Synovitis

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A young boy with deforming arthropathy

Article Abstract:

A 15-year-old boy developed painless swelling of the finger joints in his hands. He had been treated with antiarthritis medication for several years, without benefit. The results of diagnostic tests were normal. Doctors diagnosed Thiemann's disease, a congenital condition which often affects children and produces progressive enlargement of the joints in the hands and toes. Although rare, the correct diagnosis of this disorder prevents unnecessary treatment with arthritis medications.

Diagnosis, Diseases, Familial diseases, Fingers, Osteochondrosis, Osteochondritis

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