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Arthritis Deformans Clinical Features Condition of the Joints Coal Muscles

distribution, lesions, joint, disease, acute and rule

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Cases of multiple arthritis deformans fall into three main classes winch may he described respectively as acute, subacute, and chronic. In the acute cases, which are more commonly met with in younge• patients, the disease may easily be mistaken for acute rheumatism at . its onset, and the diagnosis is rendered the more difficult by the fact that the pain may be altogether out of proportion to any obvious en largement of the joints.

Such examples are rare in comparison with those of a more sub acute type in which the enlargement of the joints is noticeable from the outset and the pain is severe, but seldom sufficiently so to con fine the patient to bed. It is in women, usually under forty years of age, that this condition is most typically seen.

In the cases of the third or chronic class, commonly met with in persons advanced in life, the course of the disease is very slow, so that it will take many years to produce the amount of crippling that is developed in the course of a few months in the more acute cases.

Moreover the pain is, as a rule, far less severe and sometimes is quite insignificant, although the deformities may be very conspicuous.

Distribution of the Joint Lesions.—In the examples belonging to all the above types the distribution of the articular lesions tends to be very uniform. It is one of the peculiar features of arthritis defer mans, in which it differs from other articular diseases, that the small joints of the fingers and toes are especially liable to be attacked even in the earliest stages of the disease.

It is true that the joint which is particularly liable to gout is a small peripheral joint, but as gout extends it tends rather to attack the larger articulations such as the knees, wrists, and elbows, aud, as a rule, involves the finger-joints only in its later stages.

The most striking feature in the distribution of the lesions of arthritis deformans is the remarkable symmetry winch they so often present. We frequently see the corresponding joints of the two hands picked out by the disease, and the invasion of one of the larger joints is, as a rule, quickly followed by the implication of its fellow.

Sometimes a pair of joints little prone to other forms of arthritis, such as the carpo-metacarpal joints of the thumbs, are alone involved for a time.

This tendency to symmetrical distribution of the lesions, although so strikingly manifested in arthritis deformans, is not by any means confined to this. form of articular disease. In acute rheumatism the joint lesions show hardly any symmetry of arrangement, it is true, but the distribution of the subcutaneous nodules of rheumatic chil dren may be quite as symmetrical as that of the joint lesions of arthritis deformans. In gout, again, although unilateral distribution is the rule, we not infrequently see an attack in one great toe, closely followed by one in the corresponding joint of the opposite foot ; but here the peculiar circumstances of the first metatarso-phalangeal joint may be responsible for the occurrence.

Again to quote an affection not strictly articular, the syphilitic epiphysitis of infants is sometimes remarkably symmetrical. We must, therefore, be careful lest we find ourselves attaching undue weight to symmetrical distribution of lesions, as evidence of the ner vous origin of those lesions.

Even in multiple arthritis deformans, symmetry is by no means the universal rule, and cases might be quoted in which the disease was strictly limited to the joints of one side of the body; as, for ex ample, in a female patient whose right knee, elbow, and temporo maxillary joints were alone affected.

As Charcot pointed out, the special liability of the small joints of the hands and feet to be attacked early is in part due to their pe ripheral situation; the disease showing a tendency to progress cen tripetally. In some individual cases this tendency is very marked, as, for example, in the case of a woman, aged forty-six years, whose feet were first attacked and afterward the jaw-joints, ankles, knees, hands, wrists, elbows, shoulders, and hips, in the above order.

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