Arthritis Deformans Clinical Features Condition of the Joints Coal Muscles

pains, patients, nodules, pain, pitt, cramps and diseased

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It will be noticed that in this instance the nodules were tender, a very unusual feature in rheumatic cases, but which has been noticed by Newton Pitt iu other similar cases; and that they appeared at a period of life iu which the ordinary rheumatic nodules are extremely rare. These latter are indeed commonest in children and are seldom met with in patients who have passed twenty-five years of age.

Newton Pitt has found that the nodules last longer in cases of arthritis deformans than in rheumatic cases, sometimes persisting for many years, and are not associated with cardiac lesions. He further remarks that they may attain to an inch in diameter, and I also have seen examples of such large nodules. Sometimes what appear to be nodules upon the elbows are found on examination to be loose bodies in the bursa over the olecrauon.

In one case which Pitt describes, there was extensive fibrous thickening of the affected parts rather than discrete nodules, and associated with this was a marked amount of peripheral asphyxia which he ascribes to the pressure of the growth.

A case in which extensive exudations similar to those more re cently observed by Newton Pitt has been described by Middleton, of Glasgow." Pain in Arthritis Deformans.—The pains experienced by sufferers from arthritis cleformans are of several different kinds, and may be classified as follows : 1. Articular pains, clue to the morbid process in the joints; 2. Pains of a neuralgic type which are experienced in other situ ations than in the diseased joints; 3. Cramps, due to painful spasm of the muscles in the neighbor hood of diseased joints; 4. Radiating pains due to involvement of nerve roots, met with only when the vertebral column is implicated.

1. The pain in the diseased joints varies very greatly in severity, and in some cases of the most chronic type it is so slight that the patients themselves lay but little stress upon it, being far more con cerned at the disfigurement which the disease produces. On the other hand it is often very severe, and may cause intense suffering. Movement tends to increase the pain, and the patients frequently suffer more when warm in bed. As already mentioned, changes of weather, and even worry and anxiety are often the causes of exacor bation. The patients, as a rule, describe this pain as haying a gnaw

ing or burning character.

The joints are apt to be most painful at a comparatively early period of their implication by the disease; that is to say, at the time when the articular cartilages are undergoing destruction; as the dis ease progresses and the ends of the bones become bared and ebur nated, the severity of the pain may be greatly diminished. Indeed one may usually give the patients the consolation of assuring them that even although the progress of the disease be not stayed by treat ment, time will at least bring alleviation of suffering.

2. The neuralgic pains have been specially dwelt upon by Kent Spender, who calls attention to a neuralgic pain in the ball of the thumb or on the inner side of the wrist, which, like the pigment spots, he looks upon as an almost pathognomonic symptom in the early stages of arthritis deformaus. To the same category may be referred the pains in the bones, which can readily be distinguished from the true articular pains.

3. Painful muscular cramps, although less common than the above, contribute materially to the sufferings of the patients. Like cramps from other causes, they are of sudden onset, and are apt to cease as suddenly as they commenced. They are met with in mus cles in the neighborhood of the diseased joints, and the joints them selves are rendered more painful by the action of the muscles upon them. I believe that Charcot was the first to call attention to such cramps as a prominent feature in some cases of arthritis deformans.

Fortunately treatment is often very effectual in relieving and also in warding off such attacks.

4. If a careful analysis is made of the pains from which patients with arthritis deformans suffer, it will be found that radiating burn ing pains, following the course of a spinal nerve, and associated with spondylitis, are decidedly less uncommon than might be supposed. They occasionally follow the course of the occipital nerves, or take the form of brachialgia or intercostal neuralgia, and sometimes as sume a very severe form.

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