Chronic Gout of Oligo-articular Distribution
The course of chronic articular gout, as has been observed, may be chequered by acute outbreaks involving three, four, or more of the larger joints. But, apart from this, there are those so-called asthenic and afebrile types of gout in which two or more joints may be the seat of a chronic gouty arthritis. In my experience it is the knees that are most frequently attacked. The joints are enlarged, the seat of more or less effusion, but the distinctive feature is the presence of deformity due to the irregularly rounded or ovoid swellings produced by uratic deposits. Enlargement of the patellæ is also present, and they lose their sharp edges, and sometimes they as well as the neighbouring articular ends are studded with small bony outgrowths, but of minimal size compared with those met with in osteoarthritis. The related bursæ, too, are often the seat of deposits, a valuable clue to diagnosis. Needless to say, such marked cases are nearly always the outcome of oft-repeated attacks, the ultimate deformity being the result of successive accretions of urate of soda laid down in the trail of the exacerbations.