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RHEUMATOID ARTHRITIS (OSTEO-ARTHRITIS...

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Originally appearing in Volume V23, Page 239 of the 1911 Encyclopedia Britannica.
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RHEUMATOID See also:

ARTHRITIS (OSTEO-ARTHRITIS, ARTHRITIS DEFORMANS) , terms employed to designate a disease or See also:group of diseases characterized by destructive changes in the See also:joints. Though it is only in comparatively See also:recent times that the disease was definitely recognized as See also:separate clinically from either See also:rheumatism or See also:gout, it is certain that it prevailed in See also:ancient times. Characteristic changes in the bones have been found in remains in tombs in See also:Egypt attributed by See also:Petrie to 1300 B.C., and ancient See also:Roman as well as See also:British See also:graves have held bones showing distinct traces of the diseases. Of See also:early medical writers, See also:Paulus Aeginata observed the lesions and seemed toconsider them distinctive. Landre See also:Beauvais in 'Soo published a description of the disease under the See also:title of Goutte asthenique primitif. The first endeavour, however, to separate rheumatoid arthritis as a distinct disease was made by See also:William See also:Heberden in 1803; while in 18o5 See also:John Haygarth recognized the difference between. it and rheumatism, and suggested the See also:term " nodosity of the joints." A wide divergence of See also:opinion during the 19th See also:century as to its relation to rheumatism and to gout gave rise to the unfortunate term " rheumatic gout." The name arthritis deformans was suggested by See also:Virchow in 1859. Various causes, such as See also:nervous origin, inherited arthritic diathesis, a relationship to rheumatism or gout, and reflex irritation, have been put foward as giving rise to the disease, but in the See also:present See also:state of medical knowledge two are most favoured. The first ascribes the disease to an infective See also:process arising from micro-organisms. Several observers have found bacteria in the synovial fluid and membranes of affected joints,—Max Schuller finding both bacilli and cocci, while in 1896 See also:Gilbert See also:Bannatyne, Wohlmann and Blaxall isolated a micro-organism, a bacillus with a bipolar staining, which they stated to be almost constantly present in the joints of patients with true rheumatoid arthritis. The second view is that the disease is the result of a chronic toxaemia produced by absorption of toxines from the See also:intestine, with perhaps some See also:error in See also:metabolism. In many cases there seems to be a distinct See also:evidence of a See also:local infection, injury being a determining See also:factor, and some families seem to have joints which are specially liable to degeneration. The disease may begin at any See also:age, for there is no doubt that persistent cases have been met with in quite See also:young See also:children; but it usually begins in early See also:middle-age, and See also:statistics seem to confirm the impression of the greater liability of See also:females.

Conditions which tend to See also:

lower the See also:general See also:health seem to See also:act as a predisposing cause to rheumatoid arthritis, e.g. See also:mental worry, uterine disorders and various lowering diseases, prominent among which are See also:influenza and See also:tonsillitis. In a number of cases in See also:women the onset occurs about the See also:time of the menopause. The method of onset varies according to the See also:form. There are four well-marked types-(1) the See also:peri-articular form, in which the most marked changes are in the synovial membrane and peri-articular tissues, and the See also:cartilage may be involved to a lesser degree. In this variety is found every grade of severity. The onset may be acute, resembling an attack of rheumatic See also:fever, for which it may be mistaken; the joints, one or more, are swollen, See also:tender and painful to the See also:touch; the temperature elevated to roo°; ror°; but unlike rheumatic fever, sweating and hyperpyrexia are uncommon. The acute See also:stage may then subside, a slight thickening remaining in the See also:capsule of the See also:joint, and the contours of the See also:limb scarcely regaining the normal; or the attack may gradually develop into the chronic form. The See also:pain varies greatly, and is not necessarily in ratio to the amount of arthritis present. Various joints may be involved, the See also:spinal vertebrae not infrequently sharing in an arthritis; the most usual joints to be attacked, however, are the See also:knee and See also:shoulder. When the knee is attacked there is commonly effusion into the joint. See also:Muscular See also:atrophy is usually present, but varies greatly in its extent. In most cases it is present to a much greater degree than can be accounted for by disuse of the muscles.

The skin has in these cases a curious glossy See also:

appearance, and pigmentations may be noticed. In chronic forms the onset is See also:gradual, one joint becoming painful and swelling, and then the others successively; in these slow forms the outlook for the recovery of the joint is not so See also:good as in the acute, and some cases may proceed to extreme deformity with little or no pain. Gradually the shape of the joint is altered; this is in a See also:great measure due to synovial thickening, and partly to the presence of osteophytes in the joint. When the affected joint is moved a distinct crepitation can be See also:felt. The muscles about the joint atrophy often to an extreme degree, and contractures supervene, flexing the See also:leg upon the thigh if the knees should be affected, and the thigh upon the See also:abdomen should the See also:hip be affected. In extreme degrees the patient may become a See also:complete cripple. Later, in many cases a quiescent stage of the disease is reached, the patients cease to suffer pain, and are inconvenienced only by the deformities in the limbs, in which a considerable degree of See also:motion may be retained. Remarkable deformities are seen in hands in which a considerable amount of usefulness still remains. See also:Dyspepsia and See also:anaemia are frequently associated with arthritis. Monarticular arthritis more particularly affects the aged; and when it affects the hip is known as morbus coxae senilis. (2) The atrophic form of arthritis is not very See also:common. The See also:chief anatomical See also:change is due to atrophy in the See also:bone and cartilage.

The disease occurs at an earlier See also:

period in See also:life than the peri-articular form, from which the initial symptoms do not markedly differ; but the disorganization in the joint is greater, dislocations frequently occur, and See also:ankylosis of the joints follows. This is the most serious form of arthritis. (3) In the hypertrophic form the anatomical changes include the formation of new bone as well as changes in the cartilage. This new-bone formation may See also:lead to progressive ankylosis in the joints. Should the vertebral See also:column be affected a rigid See also:condition of the spine. known as spondylitis deformans (" See also:poker back ") may ensue. What are termed " Heberden's nodes " are small hard knobs about the See also:size of a See also:pea frequently found upon the fingers near the terminal phalangeal joints; they rarely give rise to symptoms. Popularly ascribed to gout, these nodes are in reality a manifestation of arthritis. (4) A variety of arthritis occurring in children is known as Still's disease; in which the swelling of the joints is associated with swelling of the See also:lymph glands and of the See also:spleen. The onset is often acute, with fever and rigors; sweating is profuse and the joints are enlarged and painful. There may be much muscular wasting and See also:limitation of See also:movement in the joints, and anaemia is associated with the disease. The- treatment of rheumatoid arthritis is rarely curative, once the disease has been permanently established; and it is therefore important to begin treatment before destructive changes have taken See also:place in the joints. In the acute febrile form, which is frequently taken for rheumatism, the essential treatment is See also:rest to the affected joints, with the application of oil of See also:wintergreen; the joint should not be fixed but supported.

In the more chronic forms medicinal treatments are usually of little value. See also:

Potassium iodide is useful in some cases by promoting absorption of the hypertrophied fibrous See also:tissue, and guaiacol if administered for a sufficiently See also:long time is said to be capable of arresting the disease, diminishing the size of the joint and helping movement. Where anaemia accompanies the disease See also:iron and See also:arsenic are of value. The general health of a patient suffering from rheumatoid arthritis must be maintained, and he should live upon a dry See also:soil. Visits to See also:Aix-See also:les-Bains, See also:Buxton, See also:Bath or See also:Droitwich, with their See also:baths and shampooings, often prove useful, particularly when combined with See also:gentle See also:massage. It is a See also:mistake to keep the joints entirely at rest in the chronic forms, as this tends to the formation of contractures and ankylosis. Moderate exercise without undue fatigue is desirable. Patients should go early to See also:bed and have plenty of rest, See also:sunshine and fresh See also:air. It is important that the See also:diet should be nourishing and plentiful, and should there be intestinal putrefaction fermented See also:milk is useful. As regards the local treatment, it will be well in the See also:majority of cases to determine by the X-rays the exact state of the affected joints. Radiant See also:heat, vibration and hot-air baths are among the best treatments. The active hyperaemia induced by hot air favours restoration of movement and alleviates pain, but where there is pronounced destruction of bone and cartilage full restoration of a joint cannot take place.

Systematic exercises of the joints tend to prevent the atrophy of the adjacent muscles, and Bier's passive hyperaemia induced by the temporary use of an elastic bandage has the same results. Should an X-See also:

ray photograph reveal the presence of spurs or loose bodies in the joints interfering with See also:free movement their removal is called for. Sometimes the breaking down of adhesions under an anaesthetic is necessary, and gentle passive and later active movements of the joints should follow if freedom of use is to be gained. Recentlytreatment by See also:radium has taken a definite place in the See also:therapeutics of chronic arthritis, its analgesic properties seeming of great benefit. (H. L.

End of Article: RHEUMATOID ARTHRITIS (OSTEO-ARTHRITIS, ARTHRITIS DEFORMANS)

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