{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T05:40:04Z","timestamp":1754113204483,"version":"3.41.2"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,25]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Syphilis, caused by Treponema pallidum, is resurging globally, with diverse clinical manifestations. While musculoskeletal involvement is recognised, its role in exacerbating axial spondyloarthritis (ax-SpA) or causing infectious spondylitis is poorly understood. We report the case of a 48-year-old man with long-standing ax-SpA who experienced spontaneous remission until a severe flare triggered by primary syphilis, characterised by an ulcerative lesion on the upper lip. Imaging studies revealed ankylosis of the sacroiliac joints and new inflammatory changes in the lumbar spine. Specifically, plain radiography demonstrated complete ankylosis of the sacroiliac joints, while magnetic resonance imaging revealed bone contrast enhancement, consistent with active inflammation. Syphilis infection was confirmed both serologically and by immunohistochemical staining of tissue samples. Targeted antibiotic therapy with penicillin G and amoxicillin\u2013probenecid led to significant clinical and radiological improvement. This case highlights syphilis as a potential trigger for ax-SpA exacerbation or an infectious spinal process. Recognising syphilis in patients with unexplained axial inflammation can prevent unnecessary immunosuppressive therapy and guide effective management. With the rising incidence of syphilis, prompt diagnosis and treatment are critical for preventing spinal pathology progression and improving outcomes.<\/jats:p>","DOI":"10.1093\/mrcr\/rxaf023","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T09:36:06Z","timestamp":1747992966000},"source":"Crossref","is-referenced-by-count":0,"title":["The role of syphilis in exacerbating axial spondyloarthritis symptoms: A case report on diagnosis and management"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7867-3655","authenticated-orcid":false,"given":"Junya","family":"Kitai","sequence":"first","affiliation":[{"name":"Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Seno","sequence":"additional","affiliation":[{"name":"Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoka","family":"Kamio","sequence":"additional","affiliation":[{"name":"Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masataka","family":"Kohno","sequence":"additional","affiliation":[{"name":"Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyuki","family":"Shirase","sequence":"additional","affiliation":[{"name":"Department of Pathology and Diagnosis, Japanese Red Cross Otsu Hospital , Otsu, Shiga ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3860-0488","authenticated-orcid":false,"given":"Yutaka","family":"Kawahito","sequence":"additional","affiliation":[{"name":"Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"2025080201024394800_ref1","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/S0140-6736(22)02348-0","article-title":"Syphilis","volume":"402","author":"Peeling","year":"2023","journal-title":"Lancet"},{"key":"2025080201024394800_ref2","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1136\/ard.2009.108233","article-title":"The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection","volume":"68","author":"Rudwaleit","year":"2009","journal-title":"Ann Rheum Dis"},{"key":"2025080201024394800_ref3","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1007\/s10067-022-06458-8","article-title":"Musculoskeletal manifestations of syphilis in adults: secondary syphilis presenting with ankle inflammatory arthritis and bone involvement with calvarial and sternal lesions. What the rheumatologist needs to know","volume":"42","author":"Traczuk","year":"2023","journal-title":"Clin Rheumatol"},{"key":"2025080201024394800_ref4","first-page":"e17334","article-title":"The great impostor did it again: syphilitic arthritis","volume":"13","author":"Ao","year":"2021","journal-title":"Cureus"},{"key":"2025080201024394800_ref5","doi-asserted-by":"crossref","first-page":"e9098","DOI":"10.1097\/MD.0000000000009098","article-title":"Syphilis of the lumbar spine: a case report and review of the literature","volume":"96","author":"Yin","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"2025080201024394800_ref6","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1186\/s12879-017-2620-5","article-title":"Tertiary syphilis in the lumbar spine: a case report","volume":"17","author":"Bai","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2025080201024394800_ref7","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.idcr.2017.09.012","article-title":"Osteitis in the vertebral body due to Treponema pallidum","volume":"10","author":"Kaneshita","year":"2017","journal-title":"IDCases"},{"key":"2025080201024394800_ref8","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1136\/annrheumdis-2015-208852","article-title":"The term \u2018non-radiographic axial spondyloarthritis\u2019 is much more important to classify than to diagnose patients with axial spondyloarthritis","volume":"75","author":"Sieper","year":"2016","journal-title":"Ann Rheum Dis"},{"key":"2025080201024394800_ref9","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/j.berh.2015.04.009","article-title":"Infections and arthritis","volume":"28","author":"Mathew","year":"2014","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2025080201024394800_ref10","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1136\/annrheumdis-2021-eular.1687","article-title":"AB0648 reactive arthritis in syphilis mimicking rheumatoid arthritis: a case report","volume":"80","author":"Lao","year":"2021","journal-title":"Ann Rheum Dis"},{"key":"2025080201024394800_ref11","doi-asserted-by":"crossref","first-page":"e113","DOI":"10.1111\/j.1756-185X.2012.01748.x","article-title":"Acute exacerbation of ankylosing spondylitis after chlamydial infection in a patient well-controlled with etanercept","volume":"15","author":"Kim","year":"2012","journal-title":"Int J Rheum Dis"},{"key":"2025080201024394800_ref12","doi-asserted-by":"crossref","first-page":"768741","DOI":"10.3389\/fimmu.2021.768741","article-title":"Association between infections and risk of ankylosing spondylitis: a systematic review and meta-analysis","volume":"12","author":"Zhang","year":"2021","journal-title":"Front Immunol"},{"key":"2025080201024394800_ref13","doi-asserted-by":"crossref","first-page":"916","DOI":"10.3899\/jrheum.121192","article-title":"Antibiotics for treatment of reactive arthritis: a systematic review and meta-analysis","volume":"40","author":"Barber","year":"2013","journal-title":"J Rheumatol"},{"key":"2025080201024394800_ref14","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1002\/art.27394","article-title":"Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: a double-blind, placebo-controlled, prospective trial","volume":"62","author":"Carter","year":"2010","journal-title":"Arthritis Rheum"}],"container-title":["Modern Rheumatology Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mrcr\/advance-article-pdf\/doi\/10.1093\/mrcr\/rxaf023\/63354934\/rxaf023.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/9\/2\/rxaf023\/63354934\/rxaf023.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/9\/2\/rxaf023\/63354934\/rxaf023.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T05:02:51Z","timestamp":1754110971000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mrcr\/article\/doi\/10.1093\/mrcr\/rxaf023\/8149111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":14,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,7,25]]}},"URL":"https:\/\/doi.org\/10.1093\/mrcr\/rxaf023","relation":{},"ISSN":["2472-5625"],"issn-type":[{"type":"electronic","value":"2472-5625"}],"subject":[],"published-other":{"date-parts":[[2025]]},"published":{"date-parts":[[2025]]},"article-number":"rxaf023"}}