Tabetic Arthropathy of the Knee: A Case Series of Three Patients

Tabetic arthropathy is a destructive neurogenic joint disorder occurring as a late manifestation of tertiary syphilis. Although it has become exceedingly rare owing to early and appropriate treatment of syphilis, it remains relevant in developing countries and poses significant management challenges. We report three cases of tabetic arthropathy diagnosed in our department. A retrospective analysis was conducted on three cases of tabetic arthropathy diagnosed in our department between January 2022 and December 2025. Our series included three patients (n=3) with a mean age of 66 years and a male predominance (sex ratio M/F: 2/1). The main presenting complaint was chronic, painless, bilateral involvement of the knees, with a mean duration of seven months, without constitutional symptoms. The diagnosis of tabetic arthropathy was established based on painless bilateral arthropathy of the knees, characteristic radiological features combining destructive and hypertrophic osteoarticular lesions with intra-articular osteocartilaginous fragments and positive serologic tests in serum (3/3 patients), synovial fluid (3/3 patients), and cerebrospinal fluid (3/3 patients). Cardiovascular and neurological manifestations of tertiary syphilis were identified in one patient, consisting of aortic regurgitation and syphilitic cerebral arteritis. Treatment consisted of parenteral ceftriaxone due to the unavailability of penicillin G, the reference therapy. Tabetic arthropathy is a rare complication of neurosyphilis that remains relevant today in developing countries. The diagnosis should be considered in the presence of any destructive and painless joint disease. Given the difficulty in managing this articular form, prevention through early-stage treatment of syphilis is essential.