Analogies between Gout and the Specific Infective Arthritides
A striking parallel can be drawn between the varied manifestations of gout and those met with in specific infections. But, to begin with, we must recall that our attitude towards infective disorders, e.g., acute rheumatism, gonorrhœa, etc., is altered in that we regard them now, not as local, but general, systemic infections.
Thus, following the revelations of bacteriologists, we now, for example, recognise that in gonococcal infection not only may there be articular involvement, but that muscular and nervous lesions may be associated therewith. This same, also, in acute articular rheumatism. True, its causal organism is still sub judice, but data accumulate as to the frequency with which the muscles are involved, and, to a less extent, the sheaths of nerves.
Take dysentery, again; it, too, as Sydenham pointed out, may be complicated, not only by arthritis, but by myalgias, while more recent experience emphasises the frequency with which neuralgias are associated therewith. In syphilis, also, the association of articular, muscular, and nerve lesions is well attested; and by French physicians it is insisted that, in tubercle, myalgias and neuralgias, as well as joint disorders, are infinitely more common than is generally realised.
To sum up, this triad of arthritic, muscular, and nerve lesions, either serially or simultaneously, is the most common complication of specific infections. Now, is not this same congeries of articular, muscular, and nerve disorders precisely the clinical content of gout?
Thus its articular manifestations constitute the most striking feature of the disease. As to the muscular troubles, there is a consensus of opinion as to their relative frequency. Inflammatory foci with associated uratic deposit have been found in muscles and tendons. We may here recall that the purin bases of the body exist, not only in the bound form (nucleic acid), but also free, especially in muscular tissue, also that from such free purin bases uric acid can be as readily formed as from those liberated by disruption of nucleic acid.
Clinically, one meets with all forms of fibrositis in actual association with acute articular gout. Such may affect either the neck, shoulder, loin, or sciatic nerve. In their work on “Fibrositis,” Bassett Jones and Llewellyn have shown that the disorder develops with significant frequency in the victims of gout. This but confirms the conviction held by Gowers, Garrod, Hilton Fagge, and others, viz., that the muscular and nervous types of fibrositis are frequently and obviously related to gout.
How noteworthy the well-established proclivity of gout to involve bursæ, tendon sheaths, and fasciæ, especially the plantar! Is not this exactly paralleled in certain infections? Note the predilection of post-scarlatinal rheumatism for bursæ and tendon sheaths; that of the gonococcus for these structures as well as fasciæ, not to mention the frequency with which bursal enlargements are traceable to syphilitic, tuberculous, and other infections.
We see, therefore, that in virtue of its tendency, not only to arthritic, but also to muscular and nerve disorders, gout falls into line with the specific infections. Its predilection for bursal and fascial structures is but another evidence of affinity with this group of disorders. In view of these similitudes, one may well ask, Are not these gouty manifestations, all of them, susceptible of a like explanation, viz., that they are the outcome of an infection?
For, in reviewing the foregoing analogies, it cannot, we think, be denied that in the aggregate they are emphatically suggestive of an infective origin.