Syphilitic arthritis. Diagnostic problems with special reference to congenital syphilis.

Many clinics are now reporting a fresh increase in the number of patients (mainly males) with infectious syphilis. The rheumatism clinics may be the first to see those cases in which syphilitic disease has attacked the bones or joints of small infants, older children, teenagers, and adults. Because early infectious syphilis was extremely prevalent during and immediately after the second world war, patients who were then missed, or who were inadequately treated, may now be at the stage when gummatous lesions are to be anticipated. Such people may also be the parents of congenital syphilitic offspring. The joints may be involved at most stages of congenital and acquired syphilis. It is a protean condition, and may appear in many transitional forms between the various clinical types. In congenital syphilis, arthritis occurs in two forms, and a third form is common to both the congenital and the acquired disease. In infants the typical form is Parrot's syphilitic osteochondritis, whilst in older children "Clutton's joints" are the common manifestation (Clutton, 1886). Certain other forms are analogous to the signs of tertiary syphilis seen in adult cases of acquired syphilis. D'Arcy Power (1908) classified congenital syphilitic arthritis as follows: