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February 16, 1970

Etiology of Painless, Bilateral Knee Effusion

Author Affiliations

School of Medicine University of Miami (Fla)

JAMA. 1970;211(7):1190. doi:10.1001/jama.1970.03170070060024

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To the Editor.—  A recent discussion in your QUESTIONS AND ANSWERS dealt with the topic titled above (210:1598, 1969). An additional important cause of this entity is congenital syphilis.In the latter part of the 19th century John Clutton described the joints which have come to bear his name. Although bilateral effusion is the rule, unilateral involvement may precede the development of contralateral disease (King A, Nicol C: Venereal Diseases. London, Cassell & Co Ltd, 1964, pp 86-87; and Stokes J, Beerman H, Ingraham N: Modern Clinical Syphilology. Philadelphia, W B Sanders Co, 1944, pp 1131-1132).Although antisyphilitic treatment has no effect on the joint lesions themselves, it clearly is a diagnosis which must be excluded from the standpoint of other possible lesions. In most cases as a routine serologic test for syphilis would be positive. If results are normal, however, the physician should consider doing a fluorescent treponemal antibodyabsorption