Incidence of Gouty Stigmata in Various Types of Fibrositis
Out of 343 instances of fibrositis of the joints such stigmata of gout were present in 118 males and nine females. Of muscular types, taking as our example lumbago, we find that out of twenty-seven examples no less than ten displayed definite evidences of a gouty taint. Similarly, out of thirty-eight cases of lumbago complicated by other manifestations of fibrositis eleven males and one female were of gouty habit. Also in twenty-three cases of lumbago associated with arthritic fibrositis six males, but no females, displayed the same proclivity. Lastly, out of thirty-eight cases of lumbago complicated by right or left sciatica ten were of the same diathesis.
Passing in turn to consider this same factor in relation to sciatica, we note that out of 142 examples twenty-four men and three women were gouty. Occasionally, too, apart from glycosuria, it appears to be responsible for bilateral sciatic pains, for in three examples of this nature gout was present.
James Taylor is also very definite on this point, that, glycosuria aside, affections of individual peripheral nerves occur frequently in the gouty. There is little doubt, he says, that sciatica is “frequently present in the gouty and is sometimes directly due to that state.” While admitting that in many, if not most, cases of sciatica there are associated arthritic changes in the hip joint, he yet affirms his belief that “there are some in which the neuritis is a primary condition.”
With this statement my own experience accords, but with a reservation, viz., that the sciatic neuritis is apparently secondary to a lumbar or gluteal fibrositis, with sequential involvement of the sciatic nerve sheath and extension to the nerve trunk.
Taylor holds also that anterior crural and brachial neuritis may be directly due to gout. As to brachial neuritis, he says: “I have known it occur apart from any recognisable arthritic change in a patient who was the subject of gout.”
Having regard to the flippant manner in which the term “neuritis” is but too frequently bandied about, it is refreshing to note that in all Dr. Taylor’s cases “the existence of the neuritis” was shown “by the tenderness of the nerve trunks, the spontaneous, often severe, pain, and atrophic changes both in the skin and the muscles—the glossy skin and atrophied muscles.”
As for the involvement of other nerves, trigeminal neuralgia is held to be the most common; but, for myself, I have never felt justified in claiming any such example as gouty. Nor am I satisfied that persons of gouty habit are more prone than others to attacks of migraine.
Lastly, I cannot confirm out of my own experience Duckworth’s statement that “herpetic attacks in all varieties of ‘gout’ are common.” Nor have I seen shingles co-exist with acute gout, neither have I come across any examples of so-called gouty spinal meningitis!
In conclusion, I would submit that:—
(1) Acute articular gout is not infrequently complicated by fibrositis.
(2) The same infection that determines the articular outbreak is responsible for the concomitant muscular and nerve phenomena.
(3) Persons of gouty heritage are especially liable to fibrositis, notably lumbago and sciatica.
(4) Gout predisposes to fibrositis in that the inherent pathological attributes of gouty tissues favour the incidence of infection.
In regard of this last postulate, it is well known that gouty persons who contract gonorrhœa are more prone than the non-gouty to develop gonorrhœal rheumatism, in other words, to sustain a widespread infection involving the fibrous tissues, not only of the joints, but of the muscles and even of the nerve sheaths. With this concrete example to hand, is it not reasonable to suppose that such a constitutional taint will favour the incidence also of other infections or sub-infections, and that this may explain the relative frequency of fibrositis, not only in the actually gouty, but in those of gouty heritage, this the more cogently having regard to the fact that so much exact evidence is forthcoming in favour of local infection as the cause of all types of fibrositis?