Charcot's Arthropathy - Radiology At presentation the X-ray appearance of Charcot's joint may be normal or show a minor fracture but may already show quite gross bone destruction. A bone scan usually shows intensive uptake, indicative of bone destruction. At presentation, it is important to exclude other pathologies such as gout, infective arthritis or osteomyelitis. The first two are excluded by clinical examination, joint fluid examination and blood tests. Distinction of osteomyelitis from Acute Charcot's Arthropathy is always a difficulty. A practical rule of the thumb is that if there has not been a break in the skin it is likely to be Charcot's arthropathy.