| ICD-9-CM: |
| 274.0 - | Gouty Arthropathy (Gouty Arthritis) |
| 711 - | Arthropathy Associated with Infections |
| 712 - | Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis |
| 713 - | Arthropathy Associated with Other Disorders Classified Elsewhere |
| 716 - | Other and Unspecified Arthropathies |
| 716.1 - | Traumatic Arthropathy |
| 716.10 - | Traumatic Arthropathy, Site Unspecified |
| 716.11 - | Traumatic Arthropathy, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula |
| 716.14 - | Traumatic Arthropathy, Hand; Carpus; Metacarpus; Phalanges [Fingers] |
| 716.15 - | Traumatic Arthropathy, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint) |
| 716.16 - | Traumatic Arthropathy, Lower Leg; Fibula; Knee Joint; Patella; Tibia |
| 716.17 - | Traumatic Arthropathy, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot |
| 716.18 - | Traumatic Arthropathy, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column |
| 716.4 - | Transient Arthropathy |
| 716.5 - | Unspecified Polyarthropathy or Polyarthritis |
| 716.8 - | Other Specified Arthropathy |
| 716.9 - | Arthropathy, Unspecified; Arthritis (Acute) (Chronic) (Subacute); Articular Rheumatism (Chronic); Inflammation of Joint, NOS |
| 716.91 - | Arthropathy, Unspecified; Arthritis (Acute) (Chronic) (Subacute); Articular Rheumatism (Chronic); Inflammation of Joint, NOS, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula |
| 716.96 - | Arthropathy, Unspecified; Arthritis (Acute) (Chronic) (Subacute); Articular Rheumatism (Chronic); Inflammation of Joint, NOS, Lower Leg; Fibula; Knee Joint; Patella; Tibia |
| 716.97 - | Arthropathy, Unspecified; Arthritis (Acute) (Chronic) (Subacute); Articular Rheumatism (Chronic); Inflammation of Joint, NOS, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot |
| Arthropathy means joint disease. The disease may be localized to one joint, as with post-traumatic arthritis, or may affect multiple joints, as with osteoarthritis or rheumatoid arthritis. It may also be due to an underlying condition such as a bacterial infection (infectious, pyogenic, or septic arthritis). Neuropathic arthropathy refers to bone and joint changes that develop secondary to loss of sensation associated with various disorders, including diabetes, trauma, infection, pernicious anemia, spina bifida, or amyloidosis. Arthropathy is frequently associated with articular trauma, joint slippage (subluxation) and instability, or degenerative changes of the joint. The most common form of arthropathy is osteoarthritis, in which there is progressive loss of articular joint cartilage with reactive changes at the joint margins and subchondral bone, resulting in joint destruction.
In fully developed arthropathy, joint destruction is accompanied by enlargement of the joint from swelling caused by synovial fluid joint effusion, and the development of bony overgrowth at the joint margins (osteophyte formation). Eventually, joint deformity increases as microfractures, ligamentous looseness (laxity), and decreased muscular support occur. Increased joint laxity and periarticular fractures may also result in small pieces of bone or cartilage (loose bodies) that fragment into the joint. This may result in a grating or grinding noise when the joint is moved (crepitus), although crepitus also has other causes.
Arthropathy may be the result of degenerative joint diseases such as facet joint arthropathy or knee osteoarthritis; bleeding into a joint (intra-articular hemorrhage) from trauma or hemophilia; neuropathic arthropathy secondary to diabetes or Charcot-Marie Tooth disease (Charcot joint); inflammatory joint disorders such as rheumatoid arthritis and ankylosing spondylitis; autoimmune disorders such as ulcerative colitis, Crohn's disease, systemic lupus erythematosus, and polymyalgia; septic disorders such as osteomyelitis and septic arthritis caused by bacterial or fungal infections; and crystal-depositing disorders such as gout or pseudogout.
Degenerative arthropathy may occur as the result of a single trauma to the joint, such as an acute shoulder dislocation or as the result of a healed fracture that occurred in or around the joint (intra-articular, periarticular fracture), in which case it is called post-traumatic arthritis. It can also occur secondary to malunion of a nearby fracture that results in altered biomechanics of the joint.
Neuropathic arthropathy is the rapid destruction of joints due to a loss of sensation associated with certain diseases, resulting in impaired position sense and pain perception. Although the exact pathophysiology of neuropathic arthropathy is not known, joint destruction appears to develop when the individual who has lost deep sensation is unable to feel multiple small episodes of joint trauma that occur with certain conditions. Among conditions that are most likely to result in neuropathic arthropathy are diabetes mellitus with diabetic neuropathy, syringomyelia, spinal cord and peripheral nerve tumors, and Charcot-Marie Tooth disease. Almost any joint may be affected by neuropathic arthropathy, depending upon the underlying disease, but the knee joint is involved most frequently. Usually one to three joints are affected, normally in an asymmetrical distribution.
Gout and other crystal-associated arthropathies are caused by the deposition of monosodium urate (MSU), calcium pyrophosphate dehydrate (CPPD), calcium apatite, and calcium oxylate crystals, inducing acute or chronic osteoarthritis or periarthritis. MSU (gout) and CPPD crystal deposition (pseudogout) may also lead to degenerative arthropathy via repeated, intermittent attacks of acute arthritis. This frequently occurs in large, peripheral joints, particularly in the lower extremity.
Joint damage resulting in arthropathy may occur from the inflammatory reaction of infectious arthritis. The joint may become infected via surgery, injection, insect or animal bite, trauma, abscess, osteomyelitis, or sepsis.
Individuals with diabetes or any underlying degenerative joint conditions are more likely to develop arthropathy.Risk: Osteoarthritis is the most common type of arthropathy. It is more common in those over age 40 years and is a leading cause of disability in individuals over age 65 years (Moses). Between the ages of 40 and 70, women are more troubled with osteoarthritis than men; after age 70, the rates are the same (Brandt; Porter). Incidence and Prevalence: The exact incidence of multiple arthropathies is not known because occurrence of arthropathy is so often secondary to an underlying disease. Osteoarthritis affects over 20 million individuals in the US and is the most common articular disease worldwide (Lozada). The incidence of rheumatoid arthritis is 1% in US and global populations (Smith). The overall incidence of neuropathic arthropathy is not known, but neuropathic arthropathy associated with diabetes is estimated at 15% of diabetic patients in the US and worldwide (Khan). |
Source: Medical Disability Advisor
| History: The individual may report recent trauma or acute onset of joint pain or pain may be more gradual and chronic in nature. Individuals may describe symptoms occurring at any joint in the body, with severity of pain ranging from dull to sharp, aching to throbbing. The joint may be stiff and painful with movement or weight bearing. Red, hot, and swollen joints may be reported. The individual may feel feverish if infectious arthritis is present; fever, malaise, and weight loss may also accompany severe rheumatoid arthritis. To help identify possible underlying causes, the individual should be asked to describe whether symptom onset was gradual or sudden and whether symptoms are constant or intermittent. A history of current and previous illnesses and injury will be obtained. Physical exam: Stiffness or decreased joint range of motion may be evident in the individual's posture or gait pattern. The joint may be warm to the touch (palpation) and may be sensitive or reddened. Accumulation of fluid (joint effusion) may be present. When joint range of motion is tested, there may be palpable crepitus, and there usually is at least some reduction in joint motion. A full physical examination will be conducted to assess health status and identify signs and symptoms of an underlying disease. Tests: Blood tests can detect inflammation and rule out some underlying conditions. Tests may include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein. A blood chemistry panel and various tests to detect the presence of specific antibodies in the blood may be needed to identify underlying diseases. Aspiration of joint synovial fluid may be necessary to culture for infective organisms responsible for systemic disease, and to examine for the presence of MSU or CPPD crystals. Polarizing light microscopy and other crystallographic techniques may be used to identify microcrystals in joint fluid.
The single finding present in all arthropathy is the loss of some (or in severe cases, all) of the joint articular cartilage, which is easily seen on x-ray. X-rays may show a swollen, deformed joint that may be subluxed. There may be significant formation of new bone (osteophytes) at the joint margins; at the spinal joints, these may be "parrot beaked" in shape. Articular cartilage calcification may be observed. In the spine, diagnostic nerve blocks may be indicated to determine the location of the arthropathy. MRI and CT scans can help diagnose unidentifiable, persistent pain. A bone scan may help rule out occult fracture, stress fracture, or neoplasm. On bone scan, arthritic joints usually show at least mild increased isotope uptake. |
Source: Medical Disability Advisor
| Treatment depends upon the specific diagnosis and the underlying cause of joint pain or inflammation. Analgesic and anti-inflammatory oral medications are used in early and in late stage arthropathy. In some diseases (e.g., rheumatoid arthritis), potent anti-inflammatory medications may be used to reduce the destructive inflammatory process, and immunosuppressive drugs, disease modifying antirheumatic drugs (DMARDS), or biologic therapies may be used to slow the progression of the disease. In other diseases such as osteoarthritis, medication may control symptoms but does not change the progression of the disease. Short-term immobilization using a resting splint or special immobilizing boot may help decrease the speed of joint destruction in a peripheral joint. Arthropathy may be treated with physical and/or occupational therapy to instruct the individual in stretching and strengthening exercises, as well as in joint protection strategies. Antibiotics may be required to treat arthropathy secondary to underlying infectious arthritis.
Painful spinal joints can be selectively injected with a local anesthetic and an anti-inflammatory corticosteroid to reduce back pain. Similarly, joints in the upper and lower limbs may be injected with an anti-inflammatory corticosteroid or with hyaluronic acid derivatives to improve joint lubrication. The pain relief from injections is temporary. If effective, the injections can be repeated.
Surgery may be required in cases of severe arthropathy. In the spine, hypertrophic facet arthropathy may require partial facetectomy, decompressive laminectomy, or spinal fusion if spinal nerves are being compressed by new bone formation. Spinal fusion may also be necessary if spinal instability is present. If a joint is unstable, arthrodesis may be necessary using stabilizing hardware (internal fixation) or bone grafting to stabilize the joint and reduce pain. Total joint replacement may be necessary (e.g., total knee or hip replacement) if joint surfaces have been destroyed. |
Source: Medical Disability Advisor
| Since arthropathy is usually a symptom of an underlying condition, the expected outcome depends on the specific diagnosis. Pain from arthropathy accompanying widespread (systemic) infection usually resolves along with the underlying condition. However, if ongoing (chronic) disease such as osteoarthritis, rheumatoid arthritis, or psoriatic arthritis is the underlying cause, symptoms may continue indefinitely. |
Source: Medical Disability Advisor
| Rehabilitation therapy for arthropathy depends on the underlying cause and location of the affected joint. The goal of treatment is to decrease pain and inflammation, increase function, and teach patients how to manage their symptoms. Some conditions associated with arthropathy are progressively debilitating and may eventually cause permanent joint damage. Physical therapy for these individuals may be intermittent and aims to maintain joint mobility and strength as the condition progresses. Since arthropathy is often progressively destructive, other therapeutic interventions such as pain management, occupational therapy, or counseling may be part of the rehabilitation plan.
Initially, pain-relieving modalities such as ice or heat to reduce swelling and pain may be used in combination with stabilization or immobilization of the painful joint. Physical and/or occupational therapy treatment should then focus on improving joint range of motion, strength, and proprioception. The specific treatment protocol will depend on the underlying diagnosis. During an acute stage of joint pain, the individual is instructed to rest and possibly use a splint or protective boot on the affected joint. Individuals may be instructed to perform isometric exercises (contraction of a muscle without joint movement) during this stage, and should be educated on how to protect the affected joint.
Once the acute stage subsides, it is important to get the joint active through its full range of motion while balancing rest and exercise. Active assisted range of motion exercises are implemented as tolerated, without overstretching the joint or increasing intra-articular pressure or joint temperature. Once the subacute phase has ended, the inflammatory response in the joints will have decreased enough that the individual may begin gentle stretching and more dynamic low-resistance isotonic exercises.
The physical therapists will instruct individuals in a progression of flexibility and strengthening exercises as tolerated. Therapists educate the patient on joint mechanics and loading so that the individual can moderate the exercises according to the pain level on a given day. The individual may be instructed in the use of an assistive device to improve ambulation and to decrease loading of the affected joint. Exercises to improve strength and stability of the joint will also be utilized.
Occupational therapists may re-evaluate the person's home environment to assess everyday living activities and recommend changes to help reduce joint stress. Therapists instruct individuals to make environmental changes, learn energy conservation techniques, and use adaptive equipment to protect the affected joint on a daily basis. The individual may be instructed to wear a night splint to help reduce excess motion and joint strain during sleep. |
Source: Medical Disability Advisor
| No complications are expected from the conservative treatment of arthropathy. If surgery is required, complications such as wound infection or poor wound healing may occur. Following total joint replacement, the prosthesis may loosen or dislocate. |
Source: Medical Disability Advisor
| Limitations on physical activity may be necessary due to joint pain and stiffness, and the individual's ability to use his or her upper extremities, bear weight, or ambulate, depending on the joint or joints affected. The nature and duration of the limitations depend on the specific diagnosis, the severity of symptoms, and workplace duties. Workplace accommodations may include avoidance of tasks that require physical strength or that stress certain affected joints. Time off may be required for rest and recovery from underlying conditions such as an infection or disease, or if surgery is required. If the underlying condition causing symptoms is ongoing (chronic), the individual may require permanent reassignment to less physically demanding activities.
Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Is the underlying condition that is causing the arthropathy known?
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Has individual had any recent trauma?
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Does individual have diabetes?
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Does individual have any bacterial, fungal, or parasitic illnesses?
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Does individual have inflammatory joint disorders, autoimmune illnesses, or septic disorders?
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Has individual received blood tests? X-rays? MRI or CT scan? Bone scan?
Regarding treatment:
- Has underlying condition been determined? Is condition being treated?
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Is primary disease acute or chronic?
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Has physical or occupational therapy been prescribed?
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Is individual compliant with rehabilitation regimen?
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Does individual require a resting splint? Walking boot? Assistive device such as cane or walker?
Regarding prognosis:
- Is condition chronic? Progressive?
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Does individual have any conditions that could affect ability to recover?
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Was irreversible joint damage confirmed by radiographic studies?
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Did individual require surgery? Joint replacement? Fusion?
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Is individual's employer able to accommodate any necessary restrictions?
|
Source: Medical Disability Advisor
| Brandt, Kenneth D. "Osteoarthritis." Internal Medicine. Ed. Jay H. Stein. 5th ed. St. Louis: Mosby, Inc., 1998. 1264-1268.Lozada, Carlos J., and Eli Steigelfest. "Osteoarthritis." eMedicine. Eds. John Varga, et al. 2 Oct. 2008. Medscape. 13 Mar. 2009 <http://emedicine.medscape.com/article/330487-overview>. Moses, Scott. "Osteoarthritis." Family Practice Notebook. 2 Nov. 2008. 13 Mar. 2009 <http://www.fpnotebook.com/Rheum/Osteoarthritis/Ostrthrts.htm>. Porter, Robert S., et al., eds. "Osteoarthritis (OA)." Merck. Eds. Robert S. Porter, et al. 4 Apr. 2009. Merck & Co., Inc. 13 Mar. 2009 <http://www.merck.com/mmpe/sec04/ch034/ch034e.html#sec04-ch034-ch034e-524>. Smith, Howard R. "Rheumatoid Arthritis." eMedicine. Eds. Kristine M. Lohr, et al. 19 Nov. 2008. Medscape. 13 Mar. 2009 <http://emedicine.medscape.com/article/331715-overview>. |
Source: Medical Disability Advisor
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