Syphilis of Joints

Syphilis as an aetiological factor in arthritis is probably commoner than is generally believed. Antisyphilitic treatment is clearly indicated in all cases of syphilitic arthritis, but the response-unless in the early stages of the disease, both in the inherited and acquired forms-is in the main not encouraging.

Diagnosis is materially assisted by concomitant signs or symptoms of syphilis and blood serological and cerebrospinal fluid tests. The latter are invariably positive in the early stages but are not so reliable in late syphilitic lesions, being positive in only about 50 percent of these cases.

It need hardly be stressed that a negative blood serological tests does not exclude syphilis as the cause of the arthritis. Syphilis of the joints may occur at all stages of the disease and in both the inherited and acquired forms.

Classification of Syphilitic Arthritis

Joint lesions in inherited syphilis

1. Parrot’s syphilitic osteochondritis
2. Clutton’s joint; symmetrical hydrarthrosis (in childhood)

Joint lesions in acquired (Early) syphilis

1. Arthralgia
2. Hydrarthrosis
3. Plastic arthritis (very rare)

Joint lesions in acquired (late) syphilis Gummatous arthritis

1. The synovial form
2. The osseous form
3. Charcot’s joints (tabetic arthorpathy)

Joint Lesions Inherited Syphilis

Parrot’s syphilitic osteochondritis

This is an epiphysitis, or a juxtaepiphyseal inflammation, which occurs during the first few months of life in children with inherited syphilis. It affects the upper limbs more frequently than the lower, and is often associated with an effusion into the adjacent joint.

The gelatinous tissue breaks down to form a greenish-yellow fluid from which a strongly positive treponemea immobilization reaction is obtainable. The extremities of the bones at which growth principally takes place-knee, shoulder and writs-are more frequently involved, the epiphyseal region becoming large and tender.

Separation of the epiphysis may occur and give rise to unwillingness to move the joint-syphilitic pseudoparalysis.

The radiographic changes are irregularity of the epiphyseal line cupping of the metaphysic, widening of the articular space, thickening of the periosteum and decalcification of the neighbouring bone.

Anti-syphilitic treatment may produce complete resolution, buthte growth cartilage may be so damaged that, later, shortening or deformity arises.

Clutton’s joint’ symmetrical hydrarthrosis (in childhood)

The joint condition commonly known by this name was first described by Clutton in 1986, and consists of symmetrical hydrarthrosis of the knee in children from 8 to 16 years of age. The onset is insidious and there is no fever.

The joints are painless, and in spite of the effusion the patients are able to walk quite well. This condition when associated, as it commonly is, with eye changes and other stigmata of congenital syphilis, constitutes a striking clinical picture.

The condition shows a slow response to treatment and appears to run its own course. Spontaneous recovery may take place. Relapses are unlikely.

Joint Lesions in Acquired Syphilis

Arthralgia

Arthralgia forms part of the clinical picture in the secondary stage. It may even appear before the early rashes. The pain is never severe and can often be more correctly described as an ache.

As in tertiary syphilis, it is chiefly nocturnal. It usually affects one or more of the larger joints; there is little, if any muscular spasm; and usually at this stage there is no local swelling, heat or tendency to deformity.

The diagnosis is determined by the history and general phenomena and the positive Wassermann reaction.

Hydrarthrosis

Later in the secondary stage serous synovitis may occur. It usually involved two or more joints, especially the knees and often in a symmetrical manner. In the knees and often in a symmetrical manner.

In the earlier cases the synovitis is of a transient nature, but later is more persistent. Fluid is abundant and the syonvial membrane is swollen. Pain is moderate, and gentle passive movement does not hurt, although direct pressure on the joints may do so.

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