Acute Articular Rheumatism
Unquestionably many cases of acute gouty polyarthritis have been confounded with acute articular rheumatism, and vice versâ. Garrod on this point remarks: “That many cases of acute gout have been mistaken for acute rheumatism I do not doubt, and, on the other hand, that some few cases of acute rheumatism have been regarded as of a gouty nature I am no less certain. I may refer to the oft-quoted case related by Dr. Haygarth in which gout was supposed to have been transferred from the extremities to the heart as an example of the latter error.”
It is only, of course, with that type of acute gouty polyarthritis accompanied by pyrexia, and not the afebrile variety, that confusion with acute articular rheumatism is possible. What then are the points of discrimination?
| Acute Articular Rheumatism. | Acute Gouty Polyarthritis. | |
|---|---|---|
| Age and sex | Most common between ages of fourteen and thirty. Predominance of males after twenty. | Maturity and old age. Males. Females markedly exempt. |
| Heredity | Very disputable. | Very pronounced. |
| Onset | Usually abrupt and often with tonsillitis. | Insidious, with premonitory gastro-intestinal symptoms. |
| General symptoms | High fever, sometimes hyperpyrexia. Profuse acid sweats. | Moderate pyrexia. Marked daily remissions. |
| Distribution of lesions | Preference for large joints and markedly mobile. | Small joints, hand or foot often involved. Fixity typical. |
| Local characters | Joints exhibit slight reddish flush. No subsequent desquamation. No residual change. | Scarlet hue and œdema with later peeling of cuticle and itching. Tendency to involvement of bursæ and tendons. |
| Pain | Chiefly evoked by movement. | Spontaneous, more intense. |
| Duration | Twenty to thirty days, sometimes longer. | Six weeks to three months. |
| Associated phenomena | Cardiac lesions common. | Tophi. Occasionally glycosuria and albuminuria. |
| Therapeutic test | Salicylates a specific. | Not so in gout, but colchicum takes this rôle. |