Distribution of Lesions.—Preference for large joints. Special liability of sacro-iliac, chondro-costal synchondroses, sterno-clavicular, tibio-fibular, and temporo-maxillary joints.
Local Characters.—Persistent passive effusion or peri-articular boggy swelling, with redness and local heat. No tendency to migrancy. Joint swelling very persistent.
Associated Phenomena.—Involvement of fasciæ, especially plantar, and of tendon sheaths, very distinctive, while coincident iritis or conjunctivitis is almost diagnostic.
Secondary Syphilitic Arthritis
The ease with which a subacute arthritis of this nature may be confounded with “gout” or “rheumatism” calls for comment. We have met with cases despatched to spas under this impression. The customary intermittent fever of secondary syphilis is usually present. The detection of periosteal nodes in addition to the joint swellings should arouse suspicion, while the presence of secondary syphilides and the rapid response to specific treatment will be confirmatory.
I well recollect some years ago a young farmer being sent to me by a medical man as suffering from gouty arthritis with gouty eczema. The eruption was a typical roseola, and the condition promptly cleared up under anti-syphilitic treatment.
Acute Rheumatoid or Atrophic Arthritis
While the old term “rheumatic gout” still clings to this affection, it has now achieved its isolation from gout on the one hand and rheumatism on the other. The fact that it occurs in young women in whom gout never occurs, and has a very marked clinical facies of its own, should almost preclude the possibility of its being a source of confusion. Still, for the sake of completeness, we append its chief characteristics.
Age and Sex.—Most common in young women.
Onset.—More or less acute.