Juxta-articular nodules in Euphrates Arabs

Abstract
1. 1. The literature of juxta-articular nodules is reviewed with especial reference to definition, geographical distribution, histopathology, and etiology. There is found to be general agreement upon definition and histopathology, and upon the treponematous origin of the lesions, but there is difference of opinion as to precise etiology. No adequate explanation has been given, however, for the rarity of the nodules in temperate zones in contrast to their prevalence in the tropics. 2. 2. A series of eight cases of juxta-articular nodules is reported, among Euphrates Arabs suffering from syphilis ( bejel ). A pathological study of one nodule is also presented. 3. 3. The incidence of the nodules in adult male bedouin clinic patients is 2·1 per cent. 4. 4. Such a frequency as this has been reported previously only from the tropics and in endemic yaws areas. Deir-ez-Zor, however, is well out of the tropics, and yaws has never been found in the Levant. 5. 5. We believe that the explanation of this apparent discrepancy is found in the fact that in three major respects the epidemiology of syphilis ( bejel ) in the Euphrates Arab is similar to that of the treponematous disease of the tropics. In both there is ( a ) widespread community infection, ( b ) childhood acquisition, and ( c ) general lack of treatment. 6. 6. Conversely, the absence of these three epidemiological conditions in temperate zones, gives an adequate explanation for the rarity of juxta-articular nodules in the treponematous disease of those regions. 7. 7. Syphilis under the epidemiological conditions of yaws produces juxtaarticular nodules of the same pathological character and the same order of frequency as yaws. 8. 8. The use of juxta-articular nodules as a point of differentiation between syphilis and yaws is not justified.

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