CHRONIC ARTHRITIS. The most important forms of chronic arthritis are simple ehronie arthritis, arthritis deformans, rheumatic arthritis, gouty arthritis, and tubercular arthritis. In simple chronic arthritis there is a serous exudation into the joint cavity; the synovia] membrane is thick ened, pale, and rough. The exudate may be clear, thin, and watery, or may be cloudy and thick from the presence of minute particles of fibrin, or of lymphoid or endothelial eells. The amount of fluid is sometimes large and may result in rupture of the joint capsule or in so separating the joint surfaces that dislocations occur. In that peculiar form of chronic inflammation of the joints known as arthritis deformans there is a combination of destruction of parts of the joint with new bone formation which leads to extensive deformities. The joints most commonly involved are those of the fingers, hips, knees, and feet. In gouty arthritis there is a deposit of unites in and about the joints. These deposits take place in the cartilages and in the connective tissue and in the ligaments around the joints nr even in the subcutaneous tissue. The deposit may be in the form of crystals or of whitish eon eretions. In tubercular arthritis the lesion is that of a tubercular inflammation modified by the nature of the tissues in which the inflamma tion occurs. The process may originate in the joint. but more frequently represents an extension to the joint of tubercular inflammation of the hones. Tubercular arthritis is always charac terized by the growth of tubercle tissue in and about the joint. Like tubercle tissue in other parts of the body, this tissue may vary in char acter; and, dependent upon these variations, sev eral types of tubercular arthritis arc recognized.
In sonic cases the most marked feature of the tubercular process is the degeneration of the tubercle tissue and of the adjacent joint struc tures with the formation of ulcers. This is
known as the ulcerative form of the disease. In other eases the growth of granulation tissue is very extensive, and the name 'fungous' is ap plied to this form of the disease. In still others extensive suppuration occurs, pus being present in the joint cavity and in the surrounding tis sues. This is designated suppurative tubercular arthritis. The tubercular process frequently spreads to and involves the bolus resulting in extensive changes in the bones themselves. Tu bercular arthritis is usually slow in its progress. The large joints are most frequently affected. The amount of stillness is dependent upon the extent of the process. Tubercular arthritis may occur as part of a general tubercular infection, as secondary to other tubercular lesions, or, not infrequently, is confined to a single joint with no evidence of any tubercular condition in other parts of the body.
Treatment of svnovitis or arthritis depends upon the cause. In the acute serous or scro fibrinous varieties, rest, alternate hot and cold affusion, extension of the limb so as to separate the surfaces, and exercise with the joint im movable, may be all that is necessary. In some cases passive motion is desirable, to break up adhesions, after prolonged rest in a splint. In some exudative, especially in suppurative cases. the joint is aspirated and the thiid drawn off. Rheumatic and gouty arthritis yields to the sali cylates, alkalies, lithia salts, or other internal medicine used in rheumatism or gout. In tuber cular eases the joint is opened and the tubercular nidus scooped out, o• the joint is reseeted in some instances. Deforming arthritis usually leaves permanent deformities. Sometimes opera tive procedures. undertaken after the inflamma tion has ceased, will correct these deformities in part. Consult Marsh, Diseases of the Joints and spine (London, 1895) "Joints, Diseases of," in Encyclopaalia Medico, vol. vi. (Edinburgh, 1900).