Lesions of the bones and joints in the Tertiary period of syphilis
Lesions of Bone. Lesions of the bones in the Tertiary period of syphilis is often observed, and most often affects the bones of legs and nose.
Observed the following three types of gummy bone lesions: 1) abscess, 2) osteoperiostit 3) osteomyelitis.
1. Periostitis. The first signs of gummy periostitis – is the emergence in the field of bone pain, escalating at night; shortly afterwards there is swelling in the affected bone with a sharp pain on palpation. The general condition of the patient suffers a little, apart from insomnia due to pain. If the disease remains unrecognized, or the patient is not addressed to the doctor, then after 2-3 weeks, the pain subsides, tenderness and disappears, but remains a thickening of bones or in a solid swelling, either as separate tuberosities. These changes are due to overproduction of bone by the periosteum. The resulting thickening of the bone remains for life, and on the basis of these changes can diagnose syphilis many years after the end of the process.
Remains of periodontitis is very easy to detect using radiography, and in doubtful cases, X-ray examination is the only method by which you can make a diagnosis retrospectively.
2. Osteoperiostit. The inflammatory process occurs either in the periosteum and then spreads to the bone material, either in the thickness of the bone, and then it is involved periosteum. The first symptom of the disease – a severe pain, escalating at night – the so-called boring nocturnal bone pain. With involvement of the periosteum process appears swelling in the affected bone, sharp pain on palpation. After a few weeks the inflammation subsides, pain disappears, the result is a significant thickening of the bones due to osteoneriostalnyh layers. Favourite localization of specific periostitis and osteoperiostitov – diaphysis of long bones, especially the tibia, due to frequent injuries to the bones called.
3. Osteomyelitis (osteomyelitis gummosa). Gummy osteomyelitis occurs less frequently than the previous two forms of bone disease. It occurs when the localization syphiloma in bone substance thicker as a result of the spread of the inflammatory process in the bone marrow or the localization of gumma in the bone marrow. Developing the disease by sharp pain in the affected bone, sharpens at night, and significant impairment of general condition of patients. The picture resembles a vulgar hematogenous osteomyelitis. However, fever, generally absent or less pronounced than with vulgar osteomyelitis.
Differentiate follows from tuberculous osteomyelitis. Take into account the following data: 1) syphilitic lesions localized in the diaphysis, tuberculosis – in the pineal gland; 2) with syphilitic lesions on chest radiograph osteosclerosis dominated by the phenomenon, especially in the periphery of the lesion, as in tuberculosis – the phenomenon of osteoporosis; osteosclerosis usually is weak; 3) tuberculous osteomyelitis often opened to the surface and forms a fistuleznye moves; 4) tuberculous osteomyelitis differs long, torpid course, syphilitic – less long over; 5) in cases of doubt, it is recommended to apply a test antisyphyllitic or TB treatment.
Lesions of the joints. Most other crural joint is affected with syphilis.
Clinically, the defeat of the joints in the Tertiary period is manifested in the form of: 1) and arthralgia 2) monoarthritis or synovitis.
- Arthralgia is characterized by the appearance of pain in one or more joints; joints is not changed. The intensity of the pain is not associated with the movements, on the other hand, the pain intensifies during rest, such as during sleep. The use of salicylates usually brings relief to patients, potassium iodide leads to the rapid disappearance of pain; so it is recommended in diagnostic difficulties
resort to the use of potassium iodide.
- Monoartrit (synovitis, drives, hydrarthrosis). Most affected knee joint. The clinical picture is characterized by the following symptoms: 1) appear moderate pain in the joint, typically little impeding walking; 2) the joint increases in volume due to congestion in the glenoid cavity transudate, joint edema develops.
Diagnosis. When the diagnosis should be borne in mind gonarthrocace. The following symptoms should be considered: 1) joint with syphilitic chase has a spherical shape, with tuberculosis – a spindle; 2) with joint palpation there is a lack of pain in patients with syphilis and the presence of tender points for tuberculosis; 3) movement of the joint in syphilis little limited, the patient walks; tuberculous lesions of joint function is significantly limited, the patient is usually unable to use the limb because of pain; 4) positive in some patients with syphilitic serological tests chase and negative – in tuberculous.
Keep in mind that test specific antisyphyllitic treatment of syphilitic chase may not always contribute to the resolution of the diagnostic difficulties, because its results are often observed only after 2-3 treatments.