Arthritis

“ It is estimated that more than 250,000 children in the United States suffer from some form of arthritis. A chronic inflammatory disease of unknown cause, juvenile arthritis may attack the joints and major organs of the body, such as the heart, liver, spleen, and eyes. The disease, which can last a lifetime, often makes even simple tasks difficult and frustrating for its victims. ”

“ True lobar pneumonia {384} clears up completely and the man has no symptoms once he has come through the convalescence. There are certain diseases affecting the joints, especially the arthritises in connection with various infectious diseases and the arthritis which accompanies acute arthritis deformans, in which there are serious sequelae and sometimes even complete disorganization of the joint. It is by these after-effects alone that we are sometimes able to differentiate genuine rheumatic arthritis from these other very different affections which resemble it so closely. ”

“ Rheumatoid Arthritis, or chronic Osteo-arthritis, is generally found in persons beyond middle age; but it is not rare in young people, though with them it need not be the progressive disease which it too often is in their elders. It is an obscure affection of the cartilage covering the joint surfaces of the bones, and it eventually involves the bones and the ligaments. A favourite joint for it is the knee or hip, and when one large joint is thus affected the other joints may escape. But when the hands or feet are implicated pretty nearly all the small joints are apt to suffer. ”

“ Fig. 30—Rarefying osteitis wherein articular cartilage was destroyed in a case of arthritis of fetlock joint.
Symptomatology.—In true arthritis there exists a very painful affection which is characterized by manifestations of distress. The subject may keep the extremity moving about—where pain is great—suspended and swinging. There is swelling which is more or less hot to the touch and compression of the parts with the fingers increases pain. Lameness is always pronounced and no weight is supported with the affected member in very acute and generalized arthritic inflammations. ”

“ If the infection involves all the joint structures—acute arthritis—the general and local phenomena are intensified, the temperature rises quickly, often with a rigor, and remains high; the patient looks ill, and is either unable to sleep or the sleep is disturbed by starting pains. ”

“ Orthopedic patients are those who have disease or disability of one or more joints or bones. The most common disease of joints is called arthritis, of which there are several kinds of varieties. The most common disability of bone during war-time is fracture. Arthritis usually prevents complete joint motion. In some instances the joint is put at rest to hasten healing. Almost all fractured bones are kept fixed by plaster casts or traction and prevented from movement during healing. ”

“ I allude in the first place to Charcot’s momentous discovery of the nerve arthropathies, and secondly, to the cleavage of arthritis deformans into the rheumatoid or atrophic, and the osteoarthritic or hypertrophic varieties. ”

“ Arthritis Deformans.—The shoulder is seldom affected alone, except when the arthritis is a sequel to injury, such as a fracture of the neck of the humerus. The common type of lesion is a dry arthritis with fibrillation and eburnation of the articular surfaces. The long tendon of the biceps is usually destroyed, the head of the bone is drawn upwards, and, after wearing through the capsule, rubs on the under surface of the acromion, which also becomes eburnated. ”

“ Rheumatic arthritis, if one is justified in classifying rheumatic inflammation of joints as a metastatic form of arthritis, is not a common condition, though seen in mature and aged animals. Cases that may be diagnosed with certainty are usually advanced affections wherein dependable history is obtainable and the symptoms are well marked. ”

“ Active or arterial hyperemia by baking, is especially valuable in the subacute stage.
Prognosis. In those cases in which the pain and swelling is severe and the constitutional symptoms alarming, we may always expect a true arthritis to exist. In these cases much exudate is formed in the joint, which upon organization, leads to fibrous bands and limitation of the joint function (fibrous ankylosis) . ”

“ Acute rheumatoid arthritis, which is comparatively rare, may be said to exist, rather than subacute [p. 93] articular rheumatism, if the disease affect early and chiefly the smaller joints of the hands and feet alone or along with some of the larger articulations, especially the sterno-clavicular or the temporo-maxillary; if the effusion into the joints be abundant; if inflammation persist in the articulations first involved, notwithstanding the invasion of other joints ”

“ The general symptoms arise from the absorption into the circulation of either bacteria or their toxins, and vary greatly in severity. There is either a toxemia or a septicemia, with the usual symptoms of a general sepsis.
The local symptoms are those common to synovitis and arthritis: pain, tenderness, swelling, heat, redness and loss of function. From these alone a differential diagnosis between synovitis and arthritis cannot be made. If, however, there is a sensation of crepitus conveyed to the examiner’s [Pg 89] hand upon passive motion, there is an arthritis present beyond doubt. ”

“ Arthritic hammer toe may be due to rheumatoid arthritis, gout, rheumatism, or traumatic inflammation. The variety dependent upon rheumatoid arthritis is the most common of these, and the most likely to be brought under the eye of the surgeon. Its characteristics are as follows: 1. It is not limited to the developmental period, and may occur at any age in association with the causative disease, but it is most frequently met with after middle life. ”

“ There are other groups of chronic inflammation, the origin of which continues to be the subject of controversy. Reference is here made to the chronic inflammations of the synovial membrane of joints, of tendon sheaths and of bursæ—chronic synovitis, teno-synovitis and bursitis; of the fibrous tissues of joints—chronic forms of arthritis; of the blood vessels—chronic forms of endarteritis and of phlebitis and of the peripheral nerves—neuritis. ”

“ The fever usually runs a lower course than that of genuine acute articular rheumatism, the pain is not favorably affected by salicylates, and the duration of the disease is generally longer. This affection always leaves its marks on the joints and there are always recurrences. It is, indeed, the confusion of this quite distinct disease with acute articular rheumatism that has given the latter affection the bad name it has in many minds as a producer of deformities. Arthritis deformans or general progressive arthritis is always a crippling disease ”

“ In older animals, where there exists similar conditions, with respect to their being worn from fatigue and, in addition, periarticular inflammatory organizations, arthritis is not of uncommon occurrence. ”

“ The word anchylosis signifies the stiffening of a joint. When one has read the serious changes occurring within the joint in the more serious forms of arthritis, it is easy to understand how it comes about. In suppurative arthritis, for instance, we have the synovial membrane destroyed, the articular cartilages partly or wholly obliterated, and the former boundaries of the joint entirely lost. If the animal lives, nature is bound to make repair of a sort. ”

“ There are a certain number of cases of so-called rheumatoid arthritis which produce very serious changes in joints with inevitable crippling and quite beyond all possibility of repair. These cases are often spoken of as chronic rheumatism and it is the solicitude produced by the dread of them that makes the worst part of the discomfort in many a so-called chronic rheumatic case. If their affection is to be progressive, then the patients foresee a prolonged confinement to bed in the midst of severe pain, hopeless of ultimate cure. ”

“ Otherwise, diagnosis is usually easy, as soon as lameness or synovitis, or arthritis of the lower regions of the limbs appears. Only in isolated cases are the lesions likely to be mistaken for accidental injuries, and it is also fairly easy to differentiate them from the localised lesions of rheumatism. The latter disease seems more frequently to attack the upper joints of the limbs, and is often accompanied by intense fever and cardiac disturbance. ”

“ CONSTITUTIONAL DISEASES. RHEUMATIC GOUT. (Rheumatic Arthritis. Arthritis Deformans) .—Cause.—It occurs most often from thirty to fifty-five, usually in women, generally at or after the change of life, and most frequently in those who have not had children. The involvement of the joints is most common in adult males.
Exciting cause may be: Exposure to cold and wet, improper food, unhygienic surroundings, worry, blows and acute infections. ”

“ Pyogenic diseases result from infection through the blood stream, from one of the adjacent bones, or from a penetrating wound of the joint. The commoner types include the synovitis associated with disease in the adjacent bone, acute arthritis of infants, joint suppuration in pyæmia, pyogenic arthritis following upon penetrating wounds, and the affections which result from gonorrhœal or pneumococcal infection. ”

“ Arthritis, the oldest known chronic disease, is still the Nation's greatest crippler. This disease and related rheumatic disorders afflict more than 20 million people in the United States, at an annual cost of about $4 billion, and are exceeded only by heart disease as the most common chronic illness in the country today. ”

“ The _ankylosing type_ of chronic arthritis is fortunately much rarer than those described above, and is chiefly met with in the joints of the fingers and toes and in those of the vertebral column. The synovial membrane proliferates, grows over the cartilage, and replaces it, and when two such articular surfaces are in contact they tend to adhere, thus obliterating the joint, cavity, and resulting in fibrous or bony ankylosis. ”

“ Rheumatoid Arthritis.—Rheumatoid arthritis is a chronic progressive disease with an almost hopeless prognosis as regards a complete cure. The most that can be hoped for is to arrest its progress for a longer or shorter time, and to render the patient’s life more tolerable by improving his health and relieving the pains in the affected articulations. Galvanism, massage, baths, and an invigorating diet have been found of more or less value, as well as the administration of cod-liver oil, ferruginous preparations, and the iodides. ”

“ Chronic SE Chronic SE may follow acute or subacute disease or subclinical infection and is characterized most commonly by signs of arthritis. Signs of cardiac insufficiency may be seen occasionally and will be most noticeable following exertion, sometimes causing sudden death. Chronic arthritis results in joints that show various degrees of stiffness and enlargement, sometimes as early as 3 weeks after infection. Interference with locomotion ranges from a slight limp to complete refusal to put weight on the limb, depending upon the extent of damage. ”

“ The temporo-maxillary, the sacro-iliac, the sterno-clavicular, the intervertebral, do not escape gonorrhoeal rheumatism more than they do rheumatoid or pyæmic arthritis.270 The disease most frequently invades several joints simultaneously or successively, but, soon declining in many of them, it finally becomes localized in a few or rarely in a single articulation. ”

“ The third type of arthritis deformans is the chronic slow running type which involves many joints before the process is complete. One form of this, commonly seen in old men, called osteoarthritis, is often confined to the hip joint, and often produces considerable deformity. ”

“ Both knees, or both ankles, but more commonly, only one joint, are affected, accompanied by severe constitutional symptoms. There rarely occurs any indication of sinus formation or of spontaneous drainage in this variety of arthritis, and it is held by many, that in cases where this tendency exists, there is a mixed infection, other pus producing organisms being present. ”

“ Under these conditions the prolonged or oft-repeated application of cold and damp to the peripheral nerves, severe or oft-repeated slight injuries to joints, urethral or ovario-uterine irritation, chronic gout or rheumatism, or even, exceptionally, an attack of the acute form of these diseases, may originate rheumatoid arthritis; and all wearing influences, such as anæmia, excessive menstruation, prolonged lactation, innutrition, failing health, mental anxiety, or shock, etc., act as adjuvants in the development, aggravation, and maintenance of the articular disease. ”

“ In chronic rheumatism, which is more often present in women and in the poorer classes, the moderately painful attacks of synovitis with crepitation, and evidence of wearing away of cartilage. In chronic rheumatoid arthritis the presence of bony outgrowths around the margin of the articulation is the main element of distinction from the latter condition. In tuberculous disease the personal and family history, the soft fusiform swelling, the tendency to breaking down of the morbid tissue, and the more or less complete destruction of the articular capsule in the later stages. ”

“ Symptoms.—It comes spontaneously or after only slight wounds; the person is extremely delicate. The bleedings occur from the skin, or mucous membrane, or from wounds, but rarely during menstruation or confinement. They vary from small spots to bleeding which may end fatally, or in recovery with marked anemia. There may be pain and swelling of the joints, etc., and this may leave deformities resembling deformed arthritis. The result is worse the earlier the disease shows itself. They may live to old age. ”