Case Study on Tabetic Arthropathy: Exploring the Connection between Neurological Disorders and Joint Damage

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.