In some cases benefit has followed the prolonged internal administration of liquid paraffin.
On the assumption that the condition is the result of an auto-intoxication from the intestinal tract, saline purges and irrigation of the colon are indicated, and Arbuthnot Lane claims to have brought about improvement by short-circuiting or by resecting the colon.
Residence in a warm and dry climate, with an open-air life, has been known to arrest the disease when other measures have failed to give relief.
The application of radium and the ingestion of radio-active waters have also been recommended.
Hæmophilic or Bleeder's Joint.—This is a rare but characteristic affection met with chiefly in the knee-joint of boys who are the subjects of hæmophilia. After some trivial injury, or even without apparent cause, a hæmorrhage takes place into the joint. The joint is tensely swollen, cannot be completely extended, and is so painful that the patient is obliged to lie up. The temperature is often raised (101° to 102° F.), especially if there are also hæmorrhages elsewhere. The blood in the joint is slowly re-absorbed, and by the end of a fortnight or so, the symptoms completely disappear. As a rule these attacks are repeated; the pain attending them diminishes, but the joint becomes the seat of permanent changes: the synovial membrane is thickened, abnormally vascular, and coloured brown from the deposit of blood pigment; on its surface, and in parts of the articular cartilage, there is a deposit of rust-coloured fibrin; there may be extensive adhesions, and in some cases changes occur like those observed in arthritis deformans with erosion and ulceration of the cartilage and a form of dry caries of the articular surfaces, which may terminate in ankylosis.
As the swelling of the joint is associated with wasting of the muscles, with stiffness, and with flexion, the condition closely resembles tuberculous disease of the synovial membrane. From errors in diagnosis such joints have been operated upon, with disastrous results due to hæmorrhage.
The treatment of a recent hæmorrhage consists in securing absolute rest and applying elastic compression. The introduction of blood-serum (10–15 c.c.) into a vein may assist in arresting the hæmorrhage; anti-diphtheritic serum is that most readily obtainable.
After an interval, measures should be adopted to promote the absorption of blood and to prevent stiffness and flexion; these include massage, movements, and extension with weight and pulley.
Joint Diseases associated with Lesions of the Nervous System: Neuro-Arthropathies
In Lesions of Peripheral Nerves.—In the hand, and more rarely in the foot, when one or other of the main nerve-trunks has been divided or compressed, the joints may become swollen and painful and afterwards become stiff and deformed. Bony ankylosis has been observed.