Commonly the patient tries to allevi ate the pain by keeping the affected joint semiflexed. If he is allowed to remain in this position, contraction of the ex tremity may result.
Gonorrhoeal rheumatism does not af fect the articulations alone. The serous bursae and the sheaths of the tendons in the proximity of the diseased joint are always involved; sometimes they alone suffer. The muscles of the affected ex tremity are always affected and gener ally become atrophied.
In some cases one joint only is at tacked; the pain is, then, as a rule, still more excruciating and the effusion greater than in the polyarticular form.
The acute stage of the disease is not, usually, of long duration. After some days or a week the pain declines and the effusion diminishes. The disease rarely disappears completely, however; one or more joints remain somewhat stiff and painful several months.
Suppuration of the joints affected by gonorrhceal rheumatism is a rare occur rence. It only happens when the infec tion with gonococci is complicated with the invasion of pyogenic microbes. The chronic form of gonorrhceal rheumatism often gives rise to contracture of the joints or periostitis of the epiphyses.
Diagnosis. — The diagnosis is easy when the urethral discharge is still pres ent, but difficult when it is not. The disease may be confounded with acute articular rheumatism and with osteomye litis. In gonorrhoeal rheumatism only few articulations are attacked at once. The development of the arthritis, the inefficacy of the salicylates, and, if pos sible, the demonstration of gonococci in the affected joint constitute the main distinctive signs.
rheumatism is caused by an infection with gonococci, and it is only observed as the consequence of a gonorrhoeal blennorrhagia. Many authors have found the gonococci in ma terial taken from the affected joints or synovial sheaths, and some have even observed them in the blood of the pa tients. The disease attacks both sexes equally; it may occur in children as well as in adults.
Blood taken from five individuals suf fering from gonorrhoeal rheumatism and all having gonococci in their urethral discharge. From these specimens cult ures were made; in three cases the re sult was negative, but in two bacteria were found having all the characteristics of gonococci and producing a character istic discharge upon being introduced in the vagina of a bitch. Hewes (Boston
Med. and Surg. Jour., Nov., '94).
Out of 48 cases of gonorrhmal arthritis, only 6 were women. The average age was thirty years. Only 3 had a decidedly rheumatic history. These cases seemed to show that arthritis is as liable to fol low a mild attack as a severe one. James Stewart (Montreal Med. Jour., Mar., 1900).
Acute gonorrhmal arthritis, which may be multiple, but is more often mon articular, is caused by the gonococcus and staphylococcus. Septic arthritis, puerperal or otherwise, of streptococeic infection, is generally purulent. The sec ondary multiple arthritis of acute in fectious diseases can be easily differen tiated. Multiple neuritis concerning the upper and lower limbs resembles acute rheumatism. Acute osteomyelitis and necrosis of bone may be multiple and mistaken for the above disease. Gout and acute rheumatism will not be easily confounded. Leonard Weber (Medical News, Aug. 23, 1902).
prognosis as to life is good, very often the disease results in stiffness of the affected joint and weak ness of the limb, caused by atrophy of its muscles.
In the great majority of cases gonor rhmal rheumatism in the newborn is monarticular or oligo-articular ; the knee is almost constantly involved. much more frequently than with older children and adults. The general condi tion is little affected, and fever is habit ually absent. The duration is scarcely more than a mouth, and cure results without deformity. Hausbolter (Revue Arens. des Mal. de l'Enfance; Amer. Jour. Med. Sci., Jan., '96).
Treatment. — The treatment with drugs given internally is not of great value; the salicylates have no influence on the course of the affection.
Oil of gaultheria is of value in both acute and subacute stages of gonorrheal rheumatism and comes the nearest to a specific of any of the many remedies used. It may be given in doses of from 5 to 20 drops every two hours in milk. Ichthyol ointment also recommended as a local application. Ramon Guit6ras (N. Y. Med. Jour., Mar. 24, '94).