The uncomplicated framboesioma must be pathologically similar to the gumma. Certainly the later effects of bone and joint destruction and scarring are wonderfully like some of the middle-age European descriptions “when lues was in flower.” In framboesial disease the damage from bone destruction or from contracture following cicatrization may be so complete as to render useless a finger, a hand, one of the large joints or even a whole extremity.
Bacillary Dysentery.—As far back as the 17th century (Sydenham) it was noted that joint pains or actual arthritides were occasional complications of dysentery. We now know that the bacterial types of dysentery are those most likely to show joint complications. Because the joint fluid in these lesions is usually sterile, it is assumed that they are the effect of toxins (or a toxin) produced by B. dysenteriae. Of the two hypothetical toxins of the dysentery bacillus one is supposed to produce neuritis and joint complications. Arthritides are more common in some epidemics than in others and with certain strains of bacilli than with others. The Shiga strain is the worst offender in this regard. Manson reports 27% of joint involvement in one epidemic.
Clinically, dysenteric arthritis is more apt to affect one of the larger joints, the knee, ankle and hip, being most affected. The elbow, wrist or shoulder joint may be affected, though this is unusual. The pain and swelling may be an incident of the early part of the attack. Usually it comes on when the acute symptoms are abating or as a sequela. The joint is distended with effusion and this involves the ligaments around the joint. Given an arthritis in the course of a frank dysentery there is nothing it could ordinarily be confused with. It is well to remember, however, that patients with dysentery may have also a concurrent gonorrhoea or arthritis from some focal infection. The dysenteric rheumatism ordinarily completely subsides with the cure of the colitis.
In hepatic abscess following amoebic colitis pain of some type is a frequent symptom. Rheumatic-like pains and swelling of the hands occur rarely, rapidly disappearing when the abscess is evacuated.
Filariasis.—Maitland and Bahr have noted a synovitis which is apparently a complication of filariasis. Bahr has found a fibrotic ankylosis often to follow such a joint condition. The synovitis may be followed by pus formation with serious or fatal outcome.
Guinea Worm Disease.—Very rarely the female Dracunculus may penetrate a joint and cause synovitis or arthritis.
Leprosy.—Occasionally there is joint involvement, especially of the wrist and ankle joints, in which erosion of the cartilage and bone dislocation occur giving us a condition similar to the Charcot joint.
It will be remembered that the Charcot joint is most often seen in tabes and may give one of the greatest joint swellings. As a rule only one joint, usually knee or hip, is involved in tabes and the affection is generally painless. The progress may be acute, subacute or chronic. Syringomyelia, a disease which may be confused with leprosy, may also show joint involvement, usually of the upper extremity.
Bone Affections
Mycetoma.—As the result of the invasion of an extremity—usually the foot—with the causative fungi, disorganization of the tissues involved takes place. The granulomatous process invades muscles and bones and as a result of the sinus formation we have the bones converted into a softened, cheesy mass. This disintegration of bone and other tissues is attended with little or no pain. The granules discharging through the sinuses make for a proper diagnosis.