Charcot Joints: Causes, Symptoms, Treatment and Cost

Charcot joints, also known as neuropathic arthropathy, is a condition characterized by the breaking down of bones, muscles and joints due to nerve damage. It is commonly found in people with diabetes, syphilis, AIDS and alcoholism.

Charcot joints can be divided into three distinct categories:-

• Acute Charcot Joints: Acute Charcot joints are those that develop suddenly due to nerve or circulation damage and usually affect one specific joint. They present with swelling, redness and heat at the site and may cause loss of support within the joint.
• Subacute Charcot Joints: Sub acute forms of Charcot Joints are often caused by peripheral neuropathy associated with diabetes mellitus or tabes dorsalis (neurosyphilis). They typically affect more than one joint and exhibit features similar to rheumatoid arthritis in both form and symptoms.
• Degenerative Charcot Joints: Degenerative forms of Charcot joints occur when chronic trauma leads to rapid bone erosion which causes deformity, instability and weakness within the affected area(s). This can progress over time unless treated, eventually resulting in chronic disability.

• Charcot joints, also known as neuropathic joints, are caused by nerve damage or nerve disease.
• This nerve damage interrupts the normal signals that tell the muscles and ligaments to support the joint.
• Without this signal, the joint becomes weakened and can easily become misaligned or dislocated, leading to Charcot joints.

• Early symptoms of Charcot joints often include redness, warmth, and swelling of the affected joints.
• As the condition progresses, affected joints become unstable and weakened, leading to abnormal posture and movement difficulties.
• The foot in particular may become deformed over time if not treated properly with supportive shoes or other orthotics.
• Other symptoms that may develop includes loss of sensation in the affected area as well as increased sensitivity to pain or temperature changes in the limb or joint area(s).

• Keep feet protected from injury and injury sites covered with bandage.
• Monitor feet for redness, swelling, heat and pain.
• Wear comfortable shoes that are well-fitted without pressure points or rubbing points on foot areas.
• Avoid walking barefoot or in ill-fitting shoes for extended periods of time.
• Consider using braces and orthotics to transfer load away from deforming joints of the foot and ankle at risk for breakdown of supportive structures (cycling, braces, etc.).
• Exercise routinely to maintain foot muscles, but avoid activities like jumping or running which can put extra stress on the feet and ankles.
• Wear appropriate socks that wick away moisture to help prevent infection and maintain dry skin on the feet when taking part in high impact activities like walking or running on hard surfaces or participating in sports activities like soccer, basketball, tennis etc.

• Neurological Exam: To diagnose Charcot joints, doctors typically perform a physical exam of the affected area and ask questions about existing medical conditions and previous injuries that may have caused nerve damage. Doctors may also order X-rays, MRI scans, and bone densitometry tests in order to visualize joint structure changes or tissue destruction from the condition.
• Blood Tests: A blood test to measure sugar levels is often used to diagnose diabetes if symptoms do not fully support this diagnosis. In addition,inflammation markers may be tested for signs of underlying disorders such as arthritis or gout.
• Sensory Tests: Sensory tests can detect nerve damage that could signal Charcot joints by detecting changes in sensitivity or reaction time in certain areas of the body impacted by neuropathy. Touch sensation testing can evaluate vibration responses on different parts of the body as well as hot or cold temperatures on selected areas. Light touching with a wisp of cotton can also help identify abnormal sensations indicative of nerve damage linked to Charcot's disease

• Deformity of joints: Charcot joints can cause severe deformity of the joints, leading to a distorted vision and mobility of a limb.
• Pressure Ulcers: Increased pressure concentration on an area can result in the development of wounds or pressure ulcers which are difficult to heal.
• Bone fractures: Advance stages of Charcot Joints may lead to bone fracture due to weakened bones caused by the condition.

• Applying castor oil with a warm compress: Castor oil has anti-inflammatory properties and can be used to soothe the pain from Charcot joints. Warm compresses help reduce swelling in the affected areas.
• Doing regular exercise: Low-impact exercises help keep muscles around the Charcot joint strong and reduce pain associated with deformities.
• Taking ginger-based supplements: Ginger has anti-inflammatory, antioxidant, and analgesic properties which can help reduce pain in Charcot joints. Taking supplements regularly can ensure that you are getting therapeutic levels of ginger into your body.
• Using Arnica based lotions: Applying Arnica lotion to painful areas helps ease inflammation associated with Charcot joints and can provide a cooling sensation when massaged into the area.
• Drinking turmeric tea or taking turmeric supplements: Turmeric has natural anti-inflammatory qualities, so drinking regularly or taking turmeric supplements daily may help to ease pain associated with Charcot joints and promote healing.

• Foods that are easy to chew and swallow, such as soft cooked vegetables, mashed potatoes, soups and soft fruits
• Protein-rich foods, such as eggs, fish, chicken and other lean meats
• High-fiber foods, such as whole grains, legumes and fresh fruits
• Calcium-rich foods, such as milk, yogurt and cheese
• Healthy fats like olive oil
• Plenty of fluids throughout the day to stay hydrated

• Foods high in saturated fats: These include fried and processed foods, full-fat dairy products, and red meat, as they can increase inflammation and worsen the symptoms of a Charcot joint.
• Sugar-sweetened beverages: Sugary drinks can increase inflammation and have been linked to an increased risk of developing arthritis.
• Refined carbohydrates: White flour, white rice, and other refined carbohydrates can raise blood sugar levels rapidly, leading to bone damage in those with Charcot joint.
• Alcohol: Excess alcohol consumption can increase risk for arthritis flare-ups and makes it more difficult for the body to absorb medications used for treatment of arthritic conditions such as Charcot joint.
• Caffeine: Caffeine has been linked to elevated adrenaline levels that can result in increased inflammation in those with arthritis, especially if consumed in high quantities regularly.

• Arthrodesis: This procedure involves fusing the bones of the joint together to reduce pain and improve stability.
• Osteotomy: This procedure involves cutting and realigning the bones of the joint to improve alignment and reduce pain.
• Tenotomy: This procedure involves cutting one or more of the tendons around the joint to reduce pain and improve range of motion.
• Arthroplasty: This procedure involves replacing all or part of a damaged joint with an artificial implant which can help to improve stability, reduce pain, and increase range of motion.
• Joint Debridement: This procedure involves removing damaged tissue from around a joint to reduce pain, improve stability, and increase range of motion.

The best doctor to consult for assessment and treatment of Charcot joints is an orthopedic specialist or rheumatologist.

A neurologist may also provide care if there are underlying neurological conditions that can lead to the development of Charcot joints.

The doctor will perform a physical exam, which includes checking for signs and symptoms such as swelling, weakness, tenderness and deformities in the affected area.

• Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs reduce inflammation and often help to relieve pain. Examples include ibuprofen, aspirin, and naproxen.
• Corticosteroids: These drugs reduce inflammation and can be taken orally or injected directly into the joint. Examples include prednisone and methylprednisolone.
• Disease modifying antirheumatic drugs (DMARDs): These medications slow the progression of the condition by altering or reducing the body's inflammatory response to it. Examples include methotrexate, hydroxychloroquine, sulfasalazine and leflunomide.
• Biologic agents: Biological agents are a newer class of treatments that help reduce inflammation in joints affected by Charcot joints by targeting specific components of the immune system involved in disease progression, such as tumor necrosis factor alpha inhibitors or interleukin 1 beta inhibitors. Examples include etanercept, infliximab, adalimumab and golimumab .
• Pain medications: They are used to treat chronic pain associated with Charcot joints such as opioids (e.g., codeine) or nonopioids (e..g., tramadol). Physical therapy may also provide relief from pain caused by increased instability in a joint due to Charcot Joints .

Generally speaking, recovery from Charcot Joints can be a lengthy process, with two or more years of treatment and rehabilitation being common.

Recovery can further take longer if there has been significant damage to surrounding structures such as muscles or tendons, or if surgery is needed in order to stabilize the joint.

The cost of Charcot Joints treatment in India ranges from Rs. 40,000 to Rs. 1 lakh depending on the severity of the case and type of treatment required.

The cost covers medical consultation, labs, imaging tests and any other associated treatments and therapies that may be needed to manage the condition.

• Swelling: Charcot joints treatments can lead to swelling due to the application of cold or hot packs, medications, injections, or bracing.
• Skin Breakdown: Treatment for Charcot joints can sometimes cause prolonged pressure on the skin and cause breakdown or ulceration of surrounding skin tissues.
• Pain: Even though treatment for Charcot joints is intended to reduce pain and discomfort, it can often result in aching sensations in the affected area during treatment and afterwards.
• Limited Ambulation: Depending on the severity of damage to the joint as well as effects of treatment, some patients may experience restrictions in mobility and difficulty walking even after treatments have been successful.
• Infection: Treatments for Charcot joints can put patients at risk for infection if proper wound care is not taken before and after the procedure.

A Charcot joint, also known as a Charcot–Marie–Tooth arthritis, is a type of inflammatory disorder that affects the joints of the lower limbs. It is caused by damage to the nerves and tissues in the affected area. Charcot joints may lead to deformities, difficulty walking, and difficulty with everyday tasks like bathing or dressing. Treatment may involve pharmacological methods such as pain management medications or orthopedic interventions such as braces or surgeries to correct any deformities that may have occurred.