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Clinical Varieties - Arthritis Deformans

disease, joints, joint, lesions, described and pain

CLINICAL VARIETIES - ARTHRITIS DEFORMANS.

It has already been mentioned in a previous section that the mor bid changes in the joint structures which have just been described are met with in cases which differ widely among themselves in their clinical features. In one instance a woman, perhaps not more than thirty years of age, notices an enlargement and pain on movement of the joints of her fingers, and the disease, preserving more or less of a symmetrical distribution, spreads rapidly from joint to joint, until hardly an articulation in her body escapes its invasion; the disease showing no tendency to leave those joints which were earlier attacked as fresh ones become involved. In another instance an elderly man who has perhaps sustained a slight injury in the neighborhood of one of his hips suffers from pain in the hip-joint with limitation of its movement, withOut any involvement of other articulations. As the disease slowly progresses considerable shortening of the limb may re sult and the neighboring muscles will waste, but beyond the pain and the lameness which the disease produces he may suffer but little in his general health. In both the supposed cases the lesions in the joints are of similar nature and both must be looked upon as examples of arthritis deformans. It is therefore necessary for purposes of clini cal description to classify the cases and to discuss separately the etiology and symptoms of the several varieties of the disease.

The first and most important group embraces those cases which are characterized by the affection of many joints and which may be classed together under the name of multiple arthritis deformans. This is the condition which is unfortunately so common in women of all ages and of all stations of life, but which is especially frequent about middle life ; which tends especially to invade the smaller rather than the large joints, producing, in many instances, conspicuous de formities of the hands and feet.

As a subvariety of this form may be grouped those cases in which the terminal joints of the fingers are alone affected by the disease in its most chronic form, displaying the small nodular outgrowths which are called, after the physician who first described them, Heberden's nodes.

As a second subvariety may be described a group of cases in which the lesions characteristic of arthritis deformans are devel oped as sequelm of other joint affections, such as the arthritis of acute rheumatism, of gout, or of gonorrhoea. Such secondary cases, al though they are much less common than the primary ones, must be reckoned with in an attempt to explain the pathology of the disease.

The second main group embraces those cases in which one or two joints, usually of the larger kind, are alone attacked, as in the second of the supposed cases above described. Indeed the typical example of this condition is the malum coxfe senile, the very chronic disease of the hip-joint which is not infrequently met with in elderly men.

If we adopt, as has here been done, the view that the changes in the joint structures afford the sole test of the nature of the case, and that where a certain set of morbid changes are met with there we have an example of arthritis deformans, it becomes logically necessary to include in a third main group a class of cases to which the name arthritis deformans is not usually assigned, namely, those in which, in the course of an organic disease of the great nerve centres, joint lesions closely resembling those of primary arthritis deformans are developed. Such lesions are by no means confined to locomotor ataxia, although the arthritis of that disease is the most familiar example and that to which the greatest amount of study has been devoted.

Following the classification above laid down, I propose to consider first and separately the etiology and clinical features of the primary multiple cases which constitute at the same time by far the most numerous class, and that in which the disastrous effects of the malady