Thread by @DoctorBhavsar

Juxta-articular (near joint articulations) punched out erosions on the metatarsals is indicative of GOUT | (Gout = mostly toes)

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#MedTwitter #RheumTwitter #neurotwitter #usmle

Psuedogout presents with chondrocalcinosis (calcification of cartilages) | (psuedogout = mostly knees)

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Chronic neuropathic (charcot) arthropathy presents in those with chronic diabetes and peripheral neuropathy.

Common signs on xray are :

1. Hour glass phalanges
2. Sucked candy apperance
3. Subluxation of several foot joints.

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Presentation includes inflammatory changes (edema,warmth)

🔺Acute stage -> only inflammatory changes and no xray changes.
🔺Subacute stage -> both inflammatory and xray changes positive.

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The first line management for acute and subacute neuropathic arthropathy is with “Leg casting to reduce weight bearing”

Nsaids + steroids help for inflammation but the “long-term goal is to prevent further microtraumas and bone resorption.

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researchgate.net/publication/25…

Chronic neuropathic arthropathy (marked by hypertrophic repair and reduced inflammation) is not managed by casting leg , instead it is treated with :

“Foot orthotics, Surgery and Infection prevention/treatment.”

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Thanks