Polyarticular charcot: A rare case report and a literature review in Indian context

Abstract

IntroductıonNeuropathic arthropathy is a destructive form of progressive articular disease. It is also called neuropathic osteoarthritis or Charcot arthropathy. Jean-Martin Charcot was the first to describe arthropathies associated with tabs dorsalis in 1868. 1 Neuropathic joints have become far less common in India with the availability of more efficient treatment for DM, syphilis and leprosy. 2,3 Moreover, recent years have witnessed a change in the prevalence of etiologies of arthropathies. In recent years, syringomyelia and DM have emerged as the major etiologies for neuropathic joints in upper and lower limbs respectively. Literature evidence from India on neuropathic joints is scarce. The present study discusses a rare case of polyarticular Charcot, which was provisionally diagnosed as rheumatoid arthritis, and the patient had undergone treatment with DMARDs and anti-tubercular therapy. The study also reviews the available Indian publications on the same. Case reportA 48-year-old female presented with insidious onset heaviness in left arm/forearm and pain in multiple joints for 2 years. She gradually developed progressive numbness and pinprick sensations over left shoulder area, left elbow area, which gradually progressed to left forearm and left hand. She also had numbness over right hypochondrium and lower part of right breast. She also complained of multiple joints pain (both the shoulder joints, left elbow, left wrist, and left small joints of hand). She had mechanical pain in both the shoulders, knee and ankle joints. She noticed swelling in left elbow, left wrist and left small joints of hand (2nd and 3rd MCP joints and 1st CMC joints).The patient history revealed that she had been operated earlier for left elbow swelling (synovectomy + ulnar neurolysis) and was on ATT for 4 months. The patient was treated with DMARDs (methotrexate, hydroxychloroquine), corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDS). The history also revealed a wrong provisional diagnosis of rheumatoid arthritis (RA), Koch's elbow, and ulnar neuropathy.Musculoskeletal examination revealed tenderness at bilateral shoulder joints with decreased range of motion (ROM) for overhead abduction. Swollen left elbow with decreased ROM, piano key movement at left wrist, swelling and radial deviation of 1st CMC joint left side, swollen 1 st and 2 nd left MCPs, and bilateral knee crepitus were other musculoskeletal findings (Fig. 1). Nervous system examination revealed hypotonia in both the upper limbs