Bone and joint syphilis
Introduction
Introduction to bone and joint syphilis Syphilis is a sexually transmitted disease left over from the old society, and new occurrences have taken place in recent years. Syphilis of bones and joints is a manifestation of systemic syphilis infection in bones and joints. Due to the different time and route of infection, syphilis is divided into congenital and acquired. Because the syphilis in the syphilis pregnant woman invades the placenta and invades the fetus through the umbilical vein, it is congenital syphilis. Osteoarticular lesions can be produced early in this type of syphilis. Acquired syphilis is caused by the contact of the syphilis spirochete by the skin or mucous membrane, invading from the crack and the broken part, and a few are transmitted by blood transfusion. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of transmission: 1. Sexual contact transmission 2. Blood-borne transmission 3. Placenta transmission 4. Transmission of the birth canal 5. Indirect contact transmission Complications: viral meningitis bone hyperplasia
Cause
Causes of bone and joint syphilis
Syphilis is caused by infection with Treponema pallidum, which is a kind of sexually transmitted diseases. The first phase of acquired syphilis does not invade bones and joints, and the second and third stages can cause bone and joint lesions.
According to the development of the lesion, syphilis can be divided into three phases:
1 stage syphilis, which produces proliferative inflammation after local infection, and can form "hard chancre."
2 secondary syphilis, in the rash period, occurs more than 1 to 3 months after infection, due to the spread of the whole body through the blood flow, forming a common lymphadenopathy.
3 third-phase syphilis, in this period bone, liver, cardiovascular and nervous system can be affected, more than a few months to several decades after the onset.
The syphilis of bone and joint can also be divided into congenital and acquired. In addition to the special manifestations of osteochondritis of congenital early bone syphilis, the clinical manifestations, pathological changes and X-ray findings of congenital and acquired diseases The aspects are roughly the same.
Prevention
Bone and joint syphilis prevention
Syphilis is an infectious disease mainly based on sexual contact. It can be prevented. From a long-term perspective, it is necessary to vigorously carry out the cause of the disease caused by syphilis and the harmfulness of the disease to the human body, and try to improve people's cultural level and morality. The concept and strengthening the supervision of the legal system are crucial. At the same time, the establishment of a network for the prevention and treatment of sexually transmitted diseases will enable patients with syphilis to be diagnosed early and get timely treatment.
Complication
Bone and joint syphilis complications Complications, viral meningitis, bone hyperplasia
When the skull is involved in the disease, many irregular masses can be touched on the skull to be elastic and indurated. Sometimes it can be worn into ulcers. If it develops to the deep, it can also invade the inner plate of the skull and penetrate the syphilitic meningitis inward. .
In patients with advanced syphilis, syphilitic arthritis can occur, and multiple joints of the extremities are often invaded. The most common knee joints are mild pain and limited movement. A few syphilis tumors can be broken to form fistulas, and X-rays show soft tissue swelling of the joints. There is hyperplasia and destruction of bone.
Symptom
Symptoms of bone and joint syphilis common symptoms syphilis infection calcification irritability, weight loss, bone pain, fever, osteoporosis, periostitis, saddle nose
(a) congenital early syphilis
In the late pregnancy before the onset of the disease, the early 2 to 3 weeks after birth, the clinical symptoms appear within 6 to 7 months after birth, about 70% to 80% of congenital syphilis infants can have osteochondritis lesions, surrounded by The vicinity of the epiphysis, so the lesion is more consistent with skeletal inflammation, common in the long bone metaphysis, a large number of inflammatory cell infiltration and granulation tissue formation near the epiphysis, resulting in ossification of the process, the epiphysis is widened, the basal line is not uniform, cartilage Mostly immature cells proliferate, although the interstitial cells can be calcified, but the osteoblasts have no vitality, the calcified tissue can not form trabecular bone, the lesions develop again, and the calcified interstitial is replaced by fibrous tissue and granulation tissue, ie Syphilitic granuloma, broadening of the metaphysis at the X-ray, with a band-shaped density increase on the distal side, which is a calcified cartilage area, and an irregular osteoporosis area underneath, from granulation tissue, fibrous tissue and bone The composition of the tissue, the distal epiphyseal line due to the inability of the chondrocytes to synchronize ossification, the formation of irregular jagged, severe cases of osteophyte separation, periosteal hyperplasia around the metaphysis, periostitis, common diseases Parts of the femur, humerus, ulna, radius and other long bones, mostly symmetry.
Part of the affected limb may have swelling, tenderness, muscle atrophy, sagging of the waist, and dare to move autonomously. When passively active, the baby is crying and restless. Clinically, this manifestation is pseudo-paralysis, and the child is often accompanied by Syphilitic keratitis, rash, mucosal plaque, rhinitis, nail damage, etc., while the whole body manifests as weakness, weight loss, skin loose wrinkles, often low fever, difficult to feed.
When a newborn or infant has multiple bone lesions, the possibility of syphilis should be considered. The performance of bone damage on the X-ray is helpful for diagnosis, but attention should be paid to the identification of scurvy and rickets. The syphilis is more common in the first half of life. Infants within, while other diseases are older, which is beneficial to distinguish.
(two) congenital late syphilis
Can occur at any age, but more common in 5 to 15 years old, mainly manifested as periostitis, osteitis, osteomyelitis, synovitis, pathological changes and the third phase of acquired syphilis, the main features of the tibia, femur And the obvious osteogenesis changes of the skull, such as the obvious hyperplasia of the anterior periosteum of the humerus, the shape of which is like a saber-like shape, so it is called "saber scorpion" or "sword scorpion". The lesion has local swelling, tenderness, and sometimes conscious pain. Acupuncture-like bone pain, no fever in the whole body, normal white blood cell count, severe subperiosteal infection can invade the cortex, but gum-like osteomyelitis is rare.
The sick child may have saddle nose, neurological deafness, syphilitic inflammation, phalanx and carpal bone enlargement, but no pain, X-ray showed that the phalanx has a fusiform density, the surface has a gum-like destruction, and the larger child (8 More than one year old) can have painless effusion of bilateral knee joints, affecting little activity, can relieve itself, repeated attacks do not damage the joints, there are a lot of monocytes in the joint fluid, inflammation is not obvious, no positive on X-ray Performance, called the Clutton joint.
Conjunctival bone and joint syphilis children and their mothers were positive for Kanghua's serum reaction.
(3) Acquired syphilis
The pathological changes of bone and joint occur in the second and third phases of syphilis, and the second phase may involve the periosteum, cortical bone, cancellous bone and synovial membrane, such as joint capsule, bursa and tendon sheath, among which periostitis is more common. About two-thirds, occur in the humerus, ulna, humerus, humerus, femur, tibia, etc., common in adult syphilis rash period, no change on early X-ray film, late show cortical spindle fusiform hyperplasia, bone surface Sometimes it is smooth, sometimes with worm-like defects, and inflammation in the bone marrow cavity is rare.
The third stage of the performance is more common with osteitis and osteomyelitis. Adults are infected 3 to 7 years after syphilis infection. The cortical lesions are mainly hyperplasia, and may also be accompanied by worm-like bone destruction, which is the performance of gum lesions. , can also occur in the bone marrow cavity, and can break through the soft tissue to form the fistula, the dead bone is rare, the skull is a good site, the long bone is the common tibia, ulna, humerus, humerus, the lesion can often involve the whole Bone.
When bones and joints are involved, the clinical manifestations are mainly pain, varying in severity, severe as severe as drilling, often intermittent, reduced after activity, rest and night aggravation, affecting sleep, sometimes only mild pain, localized skin lesions There are swelling, tenderness, ulcers and fistulas often appear, joint lesions manifest as joint pain and reactive effusion, some are gums arthritis, and patients with advanced spinal cord spasm can develop neurogenic arthritis, commonly known as Charcot Joints (charcot joints), clinically showing joint enlargement, instability, subluxation or dislocation, increased range of activity, characterized by no pain, X-ray see bone end sclerosis, destruction, dislocation, osteophyte hyperplasia and size Free body.
When the skull is involved, a number of irregular masses can be touched on the skull to be elastic and indurated. Sometimes it can be broken into ulcers. If it develops deep, it can also invade the inner plate of the skull and penetrate the syphilitic meningitis.
In patients with advanced syphilis, syphilitic arthritis can occur, and multiple joints of the extremities are often invaded. The most common knee joints are mild pain and limited movement. A few syphilis tumors can be broken to form fistulas, and X-rays show soft tissue swelling of the joints. There is hyperplasia and destruction of bone.
Examine
Examination of bone and joint syphilis
Common bone and joint syphilis are congenital early-onset bone syphilis and acquired bone syphilis. The X-ray manifestations of bone syphilis are multiple, symmetric and extensive osteochondritis, periostitis, osteomyelitis, in which osteochondritis is early Congenital bone syphilis has the earliest signs of X-ray. Periostitis is the most common sign. There are different degrees of periosteal hyperplasia. Some thickened periosteum and bone fusion make the backbone thicker. Osteomyelitis is mostly osteochondritis to the backbone. As a result, it is manifested as worm-like bone destruction. Some scholars believe that bone destruction and no dead bone formation are specific manifestations of this disease, and other scholars believe that this disease is not accompanied by dead bone formation when osteomyelitis changes. Only the dead bone is small.
Diagnosis
Diagnosis and differentiation of bone and joint syphilis
diagnosis
Syphilis is not very difficult to diagnose. According to its history, time of onset, clinical manifestations, changes on X-ray and positive serum of Kanghua's serum, it may not cause misdiagnosis and missed diagnosis. However, early syphilitic bone and joint lesions should be noted and Rheumatoid arthritis, tuberculous joint disease is differentiated, and advanced should be differentiated from chronic sclerosing osteomyelitis and osteosarcoma.
Differential diagnosis
(1) syphilitic periostitis needs to be differentiated from infant cortical hyperplasia, both of which have long tubular bones and symmetrical layered periosteum, but the latter is generally not affected, and the multiple onset and two and a half months after birth Less disease occurs after 5 months. The disease is a self-limiting disease that does not affect growth and development. It can often heal itself after several months.
(2) syphilitic osteochondritis needs to be identified with scurvy and rickets. The former is positive for serum syphilis, and may have a "sandwich cake" sign, while the latter occurs less frequently within 6 months.
(3) syphilitic osteomyelitis should be differentiated from suppurative osteomyelitis, the former is RPR positive, often accompanied by multiple, symmetric periostitis, dry phlegm, dead bone is small or no, the latter is acute, bone destruction by the dry end Rapid spread to the backbone, causing extensive bone destruction and large dead bone necrosis, bone hyperplasia is obvious, forming a bone capsule.
(4) Early syphilitic bone and joint lesions should be distinguished from rheumatoid arthritis and tuberculous joint disease. The late stage should be differentiated from chronic sclerosing osteomyelitis and osteosarcoma.
