Clutton syndrome describes bilateral swelling of large joints due to water retention. In this context, it is a mostly painless sequelae of connatal syphilis that does not involve any additional limitations of the patient. In both diagnosis and therapy, the recognition and treatment of syphilis is primary, and Cluton syndrome itself takes a secondary role.
What is Clutton syndrome?
Clutton syndrome refers to bilateral thickening of the large synovial membrane within the large joints. Knee joints are primarily affected. This thickening is accompanied by effusions and swelling of the so-called Clutton joint. The cause is congenital syphilis between the ages of eight and fifteen. The possibly resulting Clutton syndrome usually manifests itself between the ninth and seventeenth year of life, irrespective of sex. The syndrome is named after the Briton Henry Hugh Clutton, who was the first to notice the connection between the disease and connatal syphilis. Another name of the syndrome is syphilitic arthritis.
Causes
The mandatory cause of Clutton syndrome is connatal syphilis. This usually results from infection of the unborn child in the twentieth week of pregnancy. If congenital syphilis breaks out during childhood or adolescence, then Clutton syndrome may result. Congenital syphilis requires syphilis disease in the mother of the unborn child. This may be present before pregnancy. Infection during pregnancy is also possible and favors a vertical inheritance of the disease. The bacterial pathogen is usually transmitted sexually. The smallest injuries to the local mucous membranes are sufficient as transmission sites. Transmission via blood transfusion or open wounds is also possible.
Symptoms, complaints, and signs
Clutton syndrome is associated with a variety of symptoms that can occur in different manifestations. For example, the pain that develops during the course of the disease varies in severity depending on the patient. In addition, there is swelling of the joints, but this does not affect functional ability. An important feature is the symmetrical swelling of the affected joints. Elbows and especially knee joints are particularly frequently affected. Some patients occasionally experience numbness in the extremities adjacent to the Clutton joint. Also possible but not mandatory is swelling of the lymph nodes. In addition, there are the symptoms of congenital syphilis, which are expressed primarily as a change in the appearance of the skin.
Diagnosis and course
The disease usually progresses without fever and can therefore be suspected primarily on the basis of symptoms in a medical history. Hutchinson’s triad, i.e., barrel-shaped incisors, hearing loss, and corneal inflammation, may also be possible signs but are not necessarily pronounced. The Aquarius reaction in the blood is usually negative, but in some cases it can be positive. The goal of diagnosis is to detect congenital syphilis. This is done by newborn screening and subsequent blood tests. In combination with the typical symptoms, the diagnosis of Clutton syndrome can ultimately be made. Clutton syndrome breaks out as a result of an active syphilis disease and adds to the already existing symptoms. In addition, there is an accumulation of fluid in the joint capsules of the affected joints. This leads to swelling of the affected areas. However, the function of the joints is not impaired, so patients do not lose their independence. Occasionally, however, pain may occur. In addition, the altered appearance may affect the patient’s self-image and self-esteem.
When should you see a doctor?
As a rule, Clutton syndrome cannot be treated directly because it occurs as a sequelae of other diseases. For this reason, treatment of the underlying disease is necessary in the first instance. However, the affected person should contact a doctor if there is severe swelling of the joints, although this swelling is not associated with pain and does not occur due to a specific cause. The function of the joints is also not usually affected by the swellings.Furthermore, a doctor should be consulted if there is paralysis or disturbance of sensitivity in the extremities. The lymph nodes may also be swollen and indicate the disease. If these swellings do not go away on their own, a doctor must be consulted. The diagnosis and treatment can usually be done by a general practitioner and also leads to a positive course of the disease. Furthermore, the underlying disease that caused Clutton syndrome must also be treated.
Treatment and therapy
Because Clutton syndrome is a possible consequence of connatal syphilis disease, therapy addresses this very syphilis. Syphilis as such is usually treated with penicillin. In case of intolerance, equivalently acting agents are used for treatment. Depending on the stage of the disease, treatment lasts between ten and twenty-one days. Depending on the severity, treatment is administered by injections on an outpatient or inpatient basis. However, antibiotic treatment does not promise any success with regard to the swelling of the Clutton joints, as the disease is already too advanced. The older the patient, the more likely side effects such as fever or headaches are to occur as part of the therapy. Even after successful recovery, regular follow-up checks are necessary to prevent a new outbreak of the disease. Monthly checks are recommended during pregnancy. Once syphilis is cured, something can be done about the water retention. One drug option is diuretics, which are intended to combat the swelling of the joints. But also a conscious diet with little salt, draining teas, alternating warm baths or the elevation of the affected joints can support a reduction in swelling. It is nevertheless advisable to seek treatment in consultation with a physician.
Outlook and prognosis
In most cases, Clutton syndrome does not cause any particular limitations or complications in the life of the affected person. For this reason, the disease is not treated in every case, as it does not pose any health risk to the affected person. However, in some cases the swollen legs can lead to pain and thus reduce the quality of life of the affected person. The joints remain unaffected by this pain. Further treatment of Clutton’s syndrome usually takes place after the successful treatment of syphilis. For this reason, the course of the disease is relatively dependent on the success of the treatment of the underlying disease. In most cases, they can be removed with the help of various therapies. Even after successful treatment of syphilis, patients are still dependent on regular examinations and controls. The course of Clutton’s syndrome is usually positive. The syndrome itself cannot be prevented in the first place if the underlying disease has already broken out. To protect against syphilis, condoms should always be used during sexual intercourse. As a rule, the syndrome does not negatively affect the life expectancy of the patient.
Prevention
Because congenital syphilis is the main trigger for Clutton syndrome, unprotected sexual intercourse with syphilis patients should be avoided. Condoms, in particular, serve as protection against infection. If sexual partners change frequently, regular blood tests are recommended. In this way, syphilis can be prevented during pregnancy. Monthly prenatal examinations can also provide information about a possible infection of the unborn child. Clutton syndrome per se cannot be prevented by a patient, as it is predisposed by the previous disease. There is no way to influence the possible onset of the syndrome.
Follow-up
Treatment of Clutton syndrome is uncomplicated and rapidly completed. Immediately after treatment, sufferers must take it easy. Sports and strenuous physical activities should be avoided for at least one to two weeks. Depending on the cause of the symptoms, hygienic measures must also be taken to avoid infecting other people. Follow-up care accordingly focuses on regular check-ups. Among other things, the doctor will check blood values and perform a physical examination. Any complaints or after-effects of the treatment are discussed during a patient interview.Finally, the physician can prescribe suitable medication to balance out the therapy without pain. In the event of a severe course of the disease, further examinations may have to be performed. These include, for example, X-ray examinations or the removal of a tissue sample. If the swelling recurs after completion of treatment, there may be another underlying cause that has not yet been found. The doctor will involve other specialists in the treatment if necessary. Especially in older patients, there is a risk of permanent damage to the joints. In this case, measures such as physiotherapy are also part of the aftercare. Sick children should always be treated as inpatients. Follow-up care must also take place in a hospital so that all necessary examinations can be performed.
What you can do yourself
Since Clutton syndrome is a secondary disease of connatal syphilis, the underlying disease is treated first. Here, the affected person can contribute to a faster recovery by strengthening his general constitution and immune system. Adequate sleep and a low-fat, vitamin– and fiber-rich vegetable diet have a favorable effect. On the other hand, a lot of fat and sugar, regular consumption of meat and sausages, and too much alcohol and nicotine are disadvantageous. Anyone who feels constantly stressed should learn methods of stress management. Many health insurance companies offer free or heavily discounted nutrition courses or introductory courses in relaxation techniques such as yoga or autogenic training. It is also important to get enough physical exercise, with endurance sports such as cycling, swimming, hiking, walking or cross-country skiing in winter being particularly good for health. Clutton’s syndrome itself can be alleviated by taking diuretics. In naturopathy, medicinal plants with a diuretic effect are used. A classic is nettle tea. Pharmacies and health food stores also offer preparations based on parsley and asparagus. A low-salt diet can further support the draining effect. Elevating the affected limbs as well as cold water showers and compresses with acetic acid clay also promote decongestion.
