Case Study on Tabetic Arthropathy: Exploring the Connection between Neurological Disorders and Joint Damage
Published: 2023-04-11
Page: 46-51
Issue: 2023 - Volume 6 [Issue 1]
H. Kouame *
Laboratory of Immunology, Ibn Rochd University Hospital Center in Casablanca, Morocco.
A. Drissi Bourhanbour
Laboratory of Clinical Immunology and Immuno-Allergy (LICIA), Faculty of Medicine and Pharmacy of Casablanca, Morocco.
J. Elbakkouri
Faculty of Medicine and Pharmacy of Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Aims: Our aim is to describe the clinical, biological and radiological characteristics of Tabetic Arthropathy (TA) and to demonstrate that this pathology is still relevant in our context, illustrated by two case reports.
Case 1: A 68-year-old man, with no particular pathological history, presented painless swelling of left knee lasting for 1 year. Physical examination showed positive patella tap, painless mobilization with limited flexion ataxia, negative Romberg's test and positive Argyll Robertson pupils. Syphilitic serology was positive in blood and in joint fluid and doubtful in cerebrospinal fluid. Knee X-ray showed massive joint destruction with osteolysis and condensation of tibial plateau.
Case 2: A 54-year-old man, followed since 2010 for neuro-syphilis with tabetic arthropathy of the two hips, presented for a large painless left knee that started two months before. Physical examination showed a positive patella tap, painless mobilization with limited flexion, tabetic gait, preserved DTR with positive Romberg's test. Syphilitic serology was positive in blood, and in joint fluid. Knee X-ray showed a Genu Valgum with advanced Patellofemoral arthritis and a reconstruction image at the upper edge of the patella.
Their treatment was based on penicillin G.
Discussion: TA a rare complication of neuro-syphilis, has become exceptional due to early syphilis treatment. It is characterized by its usual indolence and the importance of bone deformities. Positive syphilitic serology in joint fluid, blood and/or CSF is essential for diagnosis. Penicillin G is the cornerstone of currently available therapies. Orthopedic treatments are suggested according to the importance of destruction. TA remains difficult to manage due to the severity of the disability, hence the importance of early diagnosis.
Conclusion: Prevention through early detection and treatment of syphilis is necessary because of therapeutic difficulties and complications of this joint form.
Keywords: Tabetic arthropathy, syphilis, serological diagnosis, penicillin G
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Yahyaoui M, Serragui S, Regragui W, Errguig L, Mouti O, Benomar A, et al. Epidemiological and clinical aspects of neurosyphilis in Morocco. EMHJ - East Mediterr Health J. 2005 ;11(3) :470-477. [Internet]. 2005 [cité 1 avr 2023]; Disponible sur.Available:https://apps.who.int/iris/handle/10665/116968
Zouhair K, Akhdari N, El Ouazzani T, Lazrak S, Lakhdar H. Tabetic arthropathy: a forgotten disease. Annals of Dermatology and Venereology. 2004;131(8‑9):787‑9.
Rafai MA, Oumari S, Boulaajaj FZ, Gynerane M, Moutawakkil BE, Slassi I. Severe tabetic arthropathy revealing neurosyphilis. NPG Neurology Psychiatry Geriatrics. 2010;10(59):225‑8.
Musher DM, Schell RF. The Immunology of Syphilis. Hosp Pract. 1975;10(12):45‑50.
Hanff PA, Fehniger TE, Miller JN, Lovett MA. Humoral immune response in human syphilis to polypeptides of Treponema pallidum. J Immunol. 1982;129(3):1287‑ 91.
Leroux M, Pasquet A, Baclet V, Alcaraz I, Melliez H, Cheret A. Neurological syphilis revealed by an evocative picture of temporal arteritis and polymyalgia rheumatica. Ann Dermatol Venereology. 2013;140(10):619‑22.
El-Fatimi A, Mkinsi O, Etaouil N, Benyahya E, Janani S, Bennis R. Tabetic arthritis of the knee: About 4 cases. Rheumatology [Internet]. 1997 [cited 2023 Jan 31].
Hsaini Y, Karouache A, Satte A, Zerhouni A, Bourazza A. Ataxia revealing tabetic arthropathy of the spine. The Medical Press. 2010;39(10):1109-11.
Kim CW, Lee CR. Multifocal neuropathic arthropathy in patient with undiagnosed neurosyphilis: A case report. Int J STD AIDS. 2017;28(7):729‑31.
Grauer JL, Drevet JG, Zagala A, Phelip X. Osteoarticular manifestations of syphilis. About two cases. Rheumatology (Aix-Bains). 1985;37(10):321‑6.
Rąpała K, Obrębski M. Charcot’s Arthropathy of the Hip Joints. J Arthroplasty. 2007;22(5):771‑4.
Charcot JM. On some arthropathies which seem to depend on a lesion of the brain or the spinal cord. Arch, physiol norm and pathol. 1868;1:161‑78.
Hsaini Y, Mounach J, Satté A, Zerhouni A, Qacif H, Mosseddaq R. Arthrotabes: about five cases. The Journal of Internal Medicine. 2007;28:101.
Tinni IA, Yaméogo NW, Compaoré V, Savadogo JE, Ouédraogo M, Zabsonré/Tiendrébéogo WJS, et al. Tabetic arthropathy: a condition not to be forgotten. Francophone African Rheumatology. 2020;3(1):24‑9.
Allali F, Rahmouni R, Hajjaj-Hassouni N. Tabetic arthropathy. A report of 43 cases. Clin Rheumatol. 2006;25(6):858‑60.
Biotti D, Fuerea R, Deschamps G, Durupt S. Neurogenic osteoarthropathy of the knee associated with spina bifida: a diagnosis not to be overlooked. The Journal of Internal Medicine. 2009;30(11):985‑7.
Ratnam S. The laboratory diagnosis of syphilis. Can J Infect Dis Med Microbiol. 2005;16(1):45‑51.
Seña AC, White BL, Sparling PF. Novel treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st century. Clin Infect Dis Off Publ Infect Dis Soc Am. 2010;51(6):700‑8.
Morshed MG, Singh AE. Recent trends in the serologic diagnosis of syphilis. Clin Vaccine Immunol CVI. 2015;22(2):137‑47.