Nerve Arthropathies
The joint disorders incidental to tabes and syringomyelia do occasionally find their way to spas for treatment under the mistaken conception that they are instances of “gout,” “rheumatism,” or “rheumatic gout.” In the case of tabes the mistake is often referable to the confounding of its lightning pains with “gout” or “rheumatism,” with subsequent relegation of the swollen joints, whether single or multiple, to one or other of these categories. In the syringomyelic it is, I think, the close resemblance that obtains between the joint lesions and those of osteoarthritis or so-called “rheumatic gout” that accounts for their uncalled-for and utterly useless transference to spas. I have known a case of syringomyelia with multiple arthropathies in the hands sent to Bath under the mistaken idea that they were of “gouty” origin.
These remarkable joint affections will be distinguished by their fulminant onset with marked effusion and absence of pain, tenderness, and heat. In addition, associated phenomena will be present, viz., ataxic pupillary changes and lost knee-jerks in tabes, while syringomyelia is characterised by dissociated anæsthesia, trophic disturbances of bones, progressive muscular atrophy with paralysis.