Osteoartropatia neurotrófica: ensaio iconográfico / Neuropathic osteoarthropathy: iconographic essay

A osteoartropatia neurotrófica caracteriza-se por uma artropatia crônica destrutiva, não-infecciosa, que se desenvolve em pacientes com alguma forma de perda da propriocepção ou da sensibilidade à dor, sendo o diabetes mellitus a causa mais freqüente no mundo contemporâneo. O quadro radiográfico clássico é o de fragmentação óssea, osteofitose, derrame e instabilidade articular, com densidade óssea preservada. Embora a radiologia convencional seja o método de imagem mais utilizado na avaliação da osteoartropatia neurotrófica, a tomografia computadorizada, a ressonância magnética e a medicina nuclear são importantes no estudo de casos complexos, especialmente quando a possibilidade de infecção for considerada. Neste artigo, as principais etio-logias da osteoartropatia neurotrófica e o papel dos métodos de imagem são abordados sob a forma de um ensaio iconográfico.

Charcot joint in a diabetic patient: an overlooked diagnosis

Charcot joint is a destructive bone and joint disorder of the foot associated with decreased sensory innervation of the involved joint, usually ending in a state of disability and amputation. In the past, tabes dorsalis was the most common cause However, with the increasing prevalence of diabetes mellitus, diabetes is now believed to be the most common cause of charcot joint. It was believed that charcot joint is rare in diabetic patieits; this could be true for the advanced stage but charcot joint is common in the early stage; however, it is usually overlooked or misdiagnosed. Diagnosis of early charcot joint requires a high index of suspicion in a neuropathic diabetic foot with a history of trauma supported by the radiological findings. Treatment is difficult and far from satisfactory in the advanced stage but if applied early it may reduce its disabling consequences. This review article describes the etiology, pathophysiology, clinical and radiological features, and treatment of charcot joint and demonstrates that a better understanding of the charcot process offers new hope for preventing the progression of this distressing diabetic complication. Therefore it is important to emphasize that early recognition and treatment of charcot joint in a diabetic patient by the physician is necessary to avoid this disabling complication and its consequences

Vibration sense and tarsal disintegration.

The extent of loss of vibration and pressure sensations was assessed in 21 leprosy patients with disintegration of the tarsus. Feet which had and did not have tarsal disintegration both showed severe impairment of pressure sensation, but the loss of vibration sense was more severe in feet which had undergone the destructive process. It appears that loss of deep sensation is an important factor in the process of tarsal disintegration in feet which are already anaesthetic. Measurement of vibration sense using a biosthesiometer may be a valuable clinical test in the investigation and follow-up of the patient with the insensitive foot to identify those at risk of developing tarsal disintegration.