PURPURA RHEIBLkTICA. PELIOSIS RHEUMATICA (Schonlein) When purpura simplex is complicated by articular pains and swell ings which dominate the disease picture, it is termed purpura rheumatica.
affection frequently commences with certain prodromal signs: lassitude, anorexia, also vomiting or diarrhoea, vague pains in the limbs which are not yet localized at the joints, sometimes urticarial eruptions. Then fever sets in, followed by the appearance of the red macules. The latter are usually a little larger than in purpura simplex, do not coalesce, and are generally found only on the legs up to just above the knee, hut may also appear in other places. They are always most numerous in the neighborhood of the joints of the extrem ities. Sometimes they protrude above the level of the skin, the extrav asation on account of its hardness being palpable.
The articular pains and swellings appear either before or after the eruption, the joints of the feet and knees being affected most frequently. The oedema is caused by serous infiltration of the periarticular parts. Thus there is no question of articular inflammation as in articular rheumatism, or of into the joints as in htemophilic articular affections. Both the absence of any cardiac involvement and the regularly favorable termination of these articular affections form further differentiating points as against. the other two affections
named.
Frequently not only the joints, but also the bones of the lower ex tremities are painful on pressure.
A peculiar point, also shared with purpura simplex, is the not infrequent combination of the with other skin affections. such as erythema nodosum, multiform exudative erythema, urticaria, etc., so that the nodules of erythema nodosum may, for example, change to blood extravasations or the urticaria wheals may be filled with blood (Neter).
In the course of the disease there are frequent collections of oedema, especially at the lower extremities, the scrotum, elbows and eyelids, although no albumin is demonstrable in the urine.
The general condition is but, slightly disturbed on the whole, but elevations of temperature up to 40° C. (104° F.) have been observed.
Course and acute cases with rapid onset the affec tion lasts about fourteen days, usually however it takes a paroxysmal course, so that a few days after the disappearance of the manifestations there appear fresh eruptions with renewed fever and other articular swellings. These relapses are especially encouraged by patients leaving the bed too soon. The termination is always favorable.