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Joint Lesions Resembling Those of Arthritis Deformans

articular, disease, conditions, synovial, locomotor, tendency, ataxia, differences and joints

JOINT LESIONS RESEMBLING THOSE OF ARTHRITIS DEFORMANS.

This is not the place in which to give any detailed description of the various forms of joint lesions which in their clinical aspects and morbid° anatomy more or less closely resemble arthritis deformans, although they are not included under that name. On the other hand, were they not to be referred to, a group of facts which serve to throw important light upon the nature and origin of arthritis deformans would be omitted, and I therefore propose to give such a short ac count of these forms of arthritis as may serve to demonstrate the similarity of the several lesions.

The joint lesions above referred to are almost exclusively met with in connection with organic diseases of the nervous system. In con nection with such nervous lesions forms of arthritis sometimes de velop which in their clinical features more closely resemble those of gout or acute rheumatism, and which tend to pas3 away under treat ment; again in connection with hemiplegia, cervical pachymeffingitis, and other conditions, stiffness of the small joints of the hands with or without enlargement occurs, which is probably due to disorders of the nutrition of the parts; but the closest approach to the phenomena of arthritis deformaus is presented in certain cases of organic disease of the spinal cord, such as locomotor ataxia and syringomyelia.

Chro.cor s Disease.—Ever since attention was first called by Charcot to the association with locomotor ataxia of a form of joint disease which now usually bears his name, it leas been recognized that although this arthritis presents, in its sudden onset and certain other clinical aspects, obvious differences from arthritis deformans, in its morbid anatomy it presents obvious and close analogies with that disease. Indeed there can be little doubt that before Charcot's discovery such lesions were habitually assigned to that category.

Such anatomical differences as separate the two groups of lesions are differences of degree rather than of kind, and the most copspicu ous of them is the far more rapid and extensive destruction of bone which contributes largely to the extreme laxity and disorganization of the affected joints. On the other hand the tendency to the forma tion of osteophytic outgrowths is decidedly less pronounced in Char cot's joint disease than in primary arthritis deformaus. The de struction of cartilage is a feature common to the two conditions, as also are the changes of the synovial membrane, viz., thickening and the formation of vinous outgrowths.

With Morraut Baker we may look upon the osteophyte formation as an attempt at repair, and may express the difference between the two conditions, by saying that in the arthropathy of locomotor ataxia the destructive far outstrip the reparative processes, whereas in osteoarthritis a more even balance is maintained.

The arthritis of syrinuomyelia presents quite as obvious resem blances to arthritis deformans as does that of locomotor ataxia. An

important case of this disease was recently described before the Clini cal Society of London by Dr. Beevor and Mr. Lunn," which was under observation for ten years and eventually came to an autopsy. Some of the diseased joints were examined by Mr. Targett, who thus describes the condition of the left shoulder-joint : "The anterior half of the glenoid cavity was entirely worn away and a new socket for the head of the humerus was formed upon the front of the neck and subscapular fossa. The margins of this socket were largely composed of new bone. The head of the humerus was likewise misshapen, being flattened considerably from before back ward; its surface in contact with the scapula was largely deficient of cartilage, and in places eburnated, while that opposed to the capsule of the joint was much nodulated. Movements in this articulation were apparently very limited. As regards the interior of the capsule and the articular surfaces generally the aspect was that of osteo arthritis. The synovial membrane was beset with villons processes, and imbedded in the fibrous tissue were the usual additaineutary bones." In this case no question arose of the accidental association with the spinal lesions of primary arthritis deformans.

-Joint Lesions in Hcemophilia. —There must not be omitted from the category of conditions which in their morbid anatomy more or less closely simulate arthritis deformans, the joint lesions to which members of families in which haemophilia prevails are subject, and which contribute largely to the sufferings of bleeders. These changes have been carefully studied by Bowlby,''' who has shown that the changes met with in the articular structures cannot be attributed in their entirety to the mere effusion of blood into the synovial capsule.

In these cases, as in arthritis deformans, the cartilaginous in of the articular ends of the bones becomes fibrillated, and in sequence assumes a velvety appearance; while in those parts which are most exposed to friction the cartilage becomes completely removed.

There is, moreover, the same tendency to the formation of carti laginous outgrowths or ecchondroses, which, in time, become con verted into osteophytes, surrounding the edges of the articular sur faces.

In certain respects, however, the arthritis of bleeders differs re markably from true arthritis deformans. In the first place the joint cavity may, and often does, contain effused blood, and extravasatious are frequently met with in the substance of the synovial membrane. Secondly, there is a great tendency to the formation of fibrous adhe sions between the articular surfaces, which very greatly limit the movements of the affected joint, whereas, as we have seen, there is no tendency whatever to the formation of such adhesions in cases of true arthritis deformans.