A 60-year old man with diabetes mellitus presents with painless, swollen right ankle joint. Radiographs of the ankle show destroyed joint with large number of loose bodies. The most probable diagnosis is:

Answer is C (Allopurinol): Allopurinol should not be used in acute gout, as it may actually precipitate an acute attack. Antiinflammatory drugs including NSAIDS (Naproxen) and Colchicine are effective in prociding rapid and safe pain relief Charcot's Joint Destructive ahritis and swollen joints in the absence ofPain suggest a diagnosis of neuropathic joint disease (Charcot joint). This is fuher suppoed by the fact that the patient isa diabetic, as diabetes is the most common cause of Charcot's joint. Neuropathic joint Disease/Charcot's joint It is progressive destructive ahritis arising from loss of pain sensation and proprioception (position sense). Clinical Presentation Begins in a single joint & progress to involve other joints. Joint becomes progressively enlarged (swollen) from bony overgrowth and synol effusion. Loose bodies may be palpated in the joint. Joint instability subluxation & crepitus occurs as the disease progresses. Patients complains of weakness, swelling, instability, laxity & progressive deformity usually involving knee or ankle. The markedly swollen joint is neither tender nor warm. The appearance suggest that movements would be agonizing and yet it is often painless. The paradox is diagnostic i.e. the amount of pain experienced is less than would be anticipated based on degree of joint involvement. Sudden pain occurs from intraaicular farctures of osteophytes or condyles Features of underlying disease Radiological Features Similar to OA i.e. joint space narrowing, subchondrial bone sclerosis, osteophytes loose bodies and joint effusion. However charcot's joimt show more marked destructive and hyperophic changes. The process is usually more rapid. Joint swelling and appearance of intraaicular calcification are fuher clues..