Its Confusion with Chronic Villous Synovitis
The frequency with which this misconception occurs is very noticeable. If a middle-aged woman of florid complexion and corpulent habit begins to complain of pain and stiffness in her knees with more or less swelling thereof, there is a very prevalent tendency to attribute not only her joint disorder to gout, but any gastric or nervous symptoms that she may simultaneously complain of are translated as being confirmatory of the assumption. It gathers weight too from the traditional and widespread belief that “the change of life” is the period par excellence at which women develop the morbid vagaries associated with “irregular gout.”
Now, as Bassett Jones and I have pointed out in a previous work, this condition, symmetrical villous synovitis of the knees, is a very common joint disorder in women at or near the menopause. Frequently they give a history of numerous pregnancies, or of rapidly increasing obesity, while with or without this latter they display a faulty postural attitude, indicative of lowered muscular and ligamentary tone. Following in the wake of these, the subject develops a symmetrical flatfoot, which, according to the stage at which it is seen, may be of flexible or rigid type.
Now, such is the mutual static interdependence of the component parts of the lower limb that this condition of flatfoot promotes or favours the incidence of villous overgrowths in the proximal joints, the knees. As to the modus operandi we have put forward the following explanation: “The everted foot, with its sunken arch, as before stated, determines an alteration in the normal coaptation of the articular surfaces in the knee, and this incongruence is revealed in skiagraphs by the marked prominence laterally of the external tibial tuberosity beneath the external femoral condyle. Coincidently, and for the same reason, additional strain is thrown upon the internal lateral ligament. This in turn favours a state of passive congestion or hyperæmia of the synovial membrane, which becomes relaxed and thrown into folds, especially at its reflexions near the edges of the cartilages. If, as often happens, the individual is the subject of varicose veins or suffers from a general lack of tone in her muscular or ligamentary structures, this tendency to venous engorgement of the knees is much enhanced.”
“Under the influence of these mechanical factors and their associated circulatory disturbances, thickening and enlargement of the synovial fringes ensue. The inflammatory condition thus produced tends to increase automatically, as, owing to the articular incongruence, the enlarged fringes are very prone to become caught between the joint surfaces; in other words, a vicious circle is produced, as with the increasing villous hypertrophy the liability to internal traumatisms increases pari passu.”