An Analysis of Bone and Joint Lesions of Known Syphilitic Origin

Abstract

A clear description of the evolution of any pathological process in bones and joints, as demonstrated by the X-ray, is often difficult to convey to others, and from the literature as found in many text books and articles on bone and joint syphilis, there is much confusion and unsatisfactory classification or standardization. Especially is this true of joint syphilis. Every known joint lesion, as hypertrophic and atrophic, arthritis, tuberculosis, osteochondritis juvenilis, exostosis, etc., has been attributed to lues. It has been stated that over 50 per cent of joints, routinely diagnosed and treated for tuberculosis, are, in reality, syphilitic and respond rapidly to antisyphilitic treatment. One writer dogmatically asserts that 10 per cent of all chronic joint affections are syphilitic; another, that there is no typical picture of joint syphilis. The Wassermann test is deemed unreliable in bone and joint syphilis and is said to be positive in only 50 per cent. In consequence, an analysis of a large number of known syphilitic bones and joints, from a radiological as well as a clinical point of view, might prove of interest on this occasion. Syphilis of bones and joints is exceedingly rare in its second stage, presenting no characteristic signs or symptoms; consequently, will be dismissed with brief mention. Gross pathological changes in bones and joints are found only in the third or tertiary stage. Trophic or parasyphilis is a different and distinct problem and will be discussed only in a very general manner. The frequency and virulence of syphilis varies as to social conditions, local morality, and intelligence of the personnel from which the estimate is derived. Statistics have usually been compiled from clinics, with patients of the lowest stratum of life and poorest hygienic conditions. Those under consideration are obtained from the records of a private orthopedic clinic and orthopedic service in general and orthopedic hospitals. A very small number were Negroes. This is a fair average of private practice in America and far above that found in the charity institutions of large cities. All were under personal supervision as to diagnosis as well as treatment. A survey was made from private records, in which there were 130 with bone and joint syphilis. In addition, there were 13 parasyphilitic joints of the Charcot type and 33 in which syphilis existed coincident to, but independent of, other affections of bones and joints. Of the 130 with bone and joint syphilis, records of the blood Wassermann test were found in 100, of which 88 were distinctly positive and 12 negative. The percentage of positive reactions has been much higher during the past five or six years, since the Wassermann test has become better standardized and more efficient. This proves the diagnostic value is about the same as in syphilis in any other portion of the body.