There are many reasons in justification of either of these treatments over the other, but in general it may be said that, in the acute stage, cold is better, while in the latter stages, heat will accomplish more to establish easy motion of the part and to lessen the danger of ankylosis.
Active or arterial hyperemia by baking, is especially valuable in the subacute stage.
Prognosis. In those cases in which the pain and swelling is severe and the constitutional symptoms alarming, we may always expect a true arthritis to exist. In these cases much exudate is formed in the joint, which upon organization, leads to fibrous bands and limitation of the joint function (fibrous ankylosis).
In the milder cases, ankylosis is the exception, if proper remedial measures are carried out.
Rheumatic Arthritis. Rheumatic articular affections are common, and are both acute or chronic. In the light of recent investigations it is believed that many of these cases are due to foci of infection in various parts of the body which pollute the blood stream with organisms which subsequently find lodgment in either the organs or joints. Infections existing in the tonsils and teeth roots have been shown to act in this way. There may, however, be cases directly attributable to rheumatism, though these are not so well understood.
Acute Rheumatism. One or several joints may be attacked simultaneously. Subsidence of the inflammation may occur, while others are becoming inflamed.
Symptoms are those of acute synovitis; suppuration never occurs unless there has been a mixed infection, and limitation of motion is a rare sequela. The pain, swelling and tenderness is extreme, and the constitutional symptoms, while being severe are not usually grave. In the chronic variety, on the other hand, there may be limitation of motion due to the formation of bands and adhesions after months or years of inflammation. This variety may start as such or may begin as an acute condition.
Treatment. The treatment, besides local rest and heat, consists of the administration of antirheumatic remedies and hygienic precautions.
Diagnosis will rest largely on the blood examination for circulating organisms, the general examination for foci of infection, and the family history.
Gouty Arthritis. Whatever may be the essential nature of gout, its manifestations are common in the smaller joints, such as the fingers and the metatarsophalanges of the great toe. Deposits of urates, chiefly sodium urate, take place in the connective tissue of the joint and also in the cartilage. Consequent upon the irritation of these salts, there is an increase in the connective tissue followed by contraction, impairment of motion, and alteration in the shape of the joint. Repeated attacks of acute inflammation occur, of greater or lesser intensity, and the uratic deposits attain a considerable size, occasionally forming abscesses or ulcerations in the overlying skin.