Copyright 2009
Definition
Scurvy is a disorder caused by a dietary deficiency of vitamin C (ascorbic acid). It is an ancient disease which was recognized by Egyptians as early as 1550 BC. Scurvy was the scourge of the sea explorers of the Renaissance era (16th-18th centuries) due to the long voyages with poor dietary consumption. In 1746, James Lind, a British naval surgeon, established the fact that oranges and lemons were effective in curing scurvy. The incidence of scurvy among the British sailors sharply declined upon routine provision of lemon juice on board. During the 19th century, people who experienced the Great Potato Famine, armies of the Crimean War and American Civil War, Arctic explorers, and California Gold Rush communities were prominent victims of “land” scurvy. In modern times scurvy is very rare in the United States with an unknown incidence.
Vitamin C is functionally most relevant for collagen synthesis, and a vitamin C deficiency results in impaired collagen synthesis. The typical pathologic manifestations of vitamin C deficiency are noted in collagen-containing tissues and in organs and tissues such as skin, cartilage, dentine, osteoid, and capillary blood vessels. Pathologic changes are a function of the rate of growth of the affected tissues; hence, the bone changes are often observed only in infants during periods of rapid bone growth.
Bone involvement is typical for infantile scurvy. This can particularly affect long bones where rapid growth takes place. The knee is one of the joints which can be affected. The bony changes occur at the junction between the end of the diaphysis and growth cartilage. Osteoblasts fail to form osteoid (bone matrix), resulting in cessation of endochondral bone formation. Calcification of the growth cartilage at the end of the long bones continues, leading to the thickening of the growth plate. The typical invasion of the growth cartilage by the capillaries does not occur. Preexisting bone becomes brittle and undergoes resorption at a normal rate, resulting in microscopic fractures of the spicules between the shaft and calcified cartilage. With these fractures, the periosteum becomes loosened, resulting in the classic subperiosteal hemorrhage at the ends of the long bones. Intra-articular hemorrhage is rare because the periosteal attachment to the growth plate is very firm.
Diagnosis is suspected clinically by history of poor nutritional intake and symptoms typical of scurvy.
Imaging includes the use of x-rays. MRIs are not needed.
Treatment options include correcting the dietary deficiency.
References
http://emedicine.medscape.com/article/985573-overview