Diagnosis will generally be known in advance from the history, through a Wassermann test of the blood, or an X-ray picture will often be of value.
In syphilis, the original focus of infection in a joint will be found in the soft tissues, while in tuberculosis, the articular ends of the bone are first involved. An examination of the discharged fragments of tissue in syphilis will show a round cell infiltration; in tuberculosis, possibly typical tubercle tissue.
Treatment by anti-syphilitic remedies, if successful, will also indicate the nature of an obscure case, a pronounced response to such treatment being a positive diagnostic aid.
Gonorrhoeal Arthritis. This affection is nearly always very acute, beginning as an acute synovitis and extending to the articular fibrocartilages at an early date.
Constitutional symptoms nearly always accompany this variety of arthritis, a chill and high temperature being the rule.
This condition is often called gonorrhoeal rheumatism. It is due to the lodgment of the gonococcus of Neisser in the joint, from the blood stream.
Gonorrhoeal arthritis is a form of septic arthritis, its pathology and symptomatology being in many respects the same. It may, in favorable cases, limit itself to the synovial membrane, in which event the symptoms will yield more readily to treatment, though the affection in any event is an acute one, and a diagnosis as to extent is difficult to make owing to the extreme pain of even slight motion.
Symptoms. These are similar to those of septic arthritis, except that usually only one joint is affected and the existence of a gonorrhoeal infection can always be determined. Both knees, or both ankles, but more commonly, only one joint, are affected, accompanied by severe constitutional symptoms. There rarely occurs any indication of sinus formation or of spontaneous drainage in this variety of arthritis, and it is held by many, that in cases where this tendency exists, there is a mixed infection, other pus producing organisms being present.
Treatment. The original infection of the urologic tract must receive the utmost care, in order to eradicate the supply of germs to the circulation. The injection of anti-gonococcic sera or vaccines finds its best application in these cases. The local treatment consists of rest and immobilization of the extremity affected.
The application of either extreme heat or cold to the joint is agreeable and efficacious.