But with repeated attacks, as in the specific infective arthritides, progressive infiltration and thickening of ligaments, capsule, and related tendinous and aponeurotic structures ensue. As far as these anatomical changes are concerned, gouty arthritis and the specific arthritides are at one, but with this outstanding difference, the associated uratic deposition. Save in respect of this last, the analogy is complete, and herein resides the specificity of gouty arthritis.
Chalmers Watson, from his observations of “gouty deposits” in human subjects in their relation to tendons, cartilage, and bone, came to the conclusion that the tout ensemble of the pathological lesions was very reminiscent of that typical of the more chronic types of infective disorders. Thus necrotic areas in gouty tendons stood in such clear relationship to the vascular supply as to suggest some infection viâ the blood-stream. Again, areas of erosion in the cartilage were found to be due, not to uric acid, but to the disintegrating action of small round cells of the nature of granulation tissue.
As to uratic deposits located in the bones, it was noted that their vicinity was characterised by marked vascularity, the existence of giant cells, and an accumulation of the small round cells so commonly correlated with the action of bacterial toxins.
In reviewing the foregoing clinical and pathological data and, alike, the inferences as to their significance, it cannot, we think, be gainsaid that, collectively, they are more readily explicable as being due to an infection than to any other morbid source.
Analogies between Gout and the Specific Infective Arthritides
A striking parallel can be drawn between the varied manifestations of gout and those met with in specific infections. But, to begin with, we must recall that our attitude towards infective disorders, e.g., acute rheumatism, gonorrhœa, etc., is altered in that we regard them now, not as local, but general, systemic infections.
Thus, following the revelations of bacteriologists, we now, for example, recognise that in gonococcal infection not only may there be articular involvement, but that muscular and nervous lesions may be associated therewith. This same, also, in acute articular rheumatism. True, its causal organism is still sub judice, but data accumulate as to the frequency with which the muscles are involved, and, to a less extent, the sheaths of nerves.
Take dysentery, again; it, too, as Sydenham pointed out, may be complicated, not only by arthritis, but by myalgias, while more recent experience emphasises the frequency with which neuralgias are associated therewith. In syphilis, also, the association of articular, muscular, and nerve lesions is well attested; and by French physicians it is insisted that, in tubercle, myalgias and neuralgias, as well as joint disorders, are infinitely more common than is generally realised.
To sum up, this triad of arthritic, muscular, and nerve lesions, either serially or simultaneously, is the most common complication of specific infections. Now, is not this same congeries of articular, muscular, and nerve disorders precisely the clinical content of gout?